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Old Age and Myocardial Injury in ST-Segment Elevation Myocardial Infarction. Am J Med Sci 2021; 362:592-600. [PMID: 34563496 DOI: 10.1016/j.amjms.2021.06.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 12/20/2020] [Accepted: 06/04/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little is known about the causality and pathological mechanism underlying the association between old age and myocardial injury in patients with ST-segment elevation myocardial infarction (STEMI). We evaluated the association between old age and myocardial injury in STEMI patients undergoing primary percutaneous coronary intervention (PCI) using cardiovascular magnetic resonance imaging (CMR). METHODS A total of 279 patients with STEMI who underwent primary PCI and CMR were enrolled. Of these, 52 patients were over the age of 70 years (18.6%, Age ≥70 group) and 227 patients were under the age of 70 years (81.4%, Age <70 group) at STEMI occurrence. We compared myocardial infarct size on CMR according to age at STEMI occurrence and performed inverse probability of treatment weighting. RESULTS On CMR analysis, myocardial infarct size on CMR tended to be greater in the Age ≥70 group than in the Age <70 group (21.2 ± 10.2% versus 19.5 ± 11.1%; p = 0.072). After performing inverse probability of treatment weighting adjustment, myocardial infarct size was significantly greater in the Age ≥70 group compared with the Age <70 group (22.6 ± 10.4% versus 19.6 ± 11.1%; p = 0.001). Subgroup analysis of patients older than 70 years revealed no significant difference in myocardial infarct size according to sex (20.1 ± 11.5% in females versus 20.4 ± 9.9% in males; p = 0.901). CONCLUSIONS Despite appropriate coronary revascularization, old age was associated with greater extent of myocardial injury in STEMI patients.
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Abstract
Admission in cardiology departments of patients over 80 years old, even nonagenarians, for ST-segment elevation myocardial infarction (STEMI) is not uncommon in 2018. The management of these high risk and polypathological patients, with atypical clinical presentation, is not based on international guidelines or randomized studies, but rather on retrospective studies, expert consensus, and common sense. Each decision has to be individualized to the patient's situation. This review, after a clinical case, aims to guide the clinician in the specific management of these patients, from the symptoms, to reperfusion strategy, and, as fast as possible, hospital discharge.
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Affiliation(s)
- Z Terzian
- Service de cardiologie, centre hospitalo-universitaire Xavier-Bichat, 46, rue Henri-Huchard, 75018 Paris, France.
| | - M Slama
- Service de cardiologie, centre hospitalo-universitaire Xavier-Bichat, 46, rue Henri-Huchard, 75018 Paris, France
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Pek PP, Zheng H, Ho AFW, Wah W, Tan HC, Foo LL, Ong MEH. Comparison of epidemiology, treatments and outcomes of ST segment elevation myocardial infarction between young and elderly patients. Emerg Med J 2018; 35:289-296. [PMID: 29545356 DOI: 10.1136/emermed-2017-206754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 02/14/2018] [Accepted: 02/26/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND With an ageing population, there is a need to understand the relative risk/benefit of interventions for elderly ST segment elevation myocardial infarction (STEMI) patients. The primary aim of this study was to compare epidemiology, treatments and outcomes between young and elderly STEMI patients. Our secondary aim was to determine the cut-off age when the benefits of primary percutaneous coronary intervention (PCI) were less pronounced. METHODS Data were collected by the Singapore Myocardial Infarction Registry. Patients were categorised into young (age <65 years) and elderly STEMI (age ≥65 years) patients. RESULTS We analysed 14 006 STEMI cases collected between January 2007 and December 2014; 33.9% were elderly STEMI patients. Elderly STEMI patients had longer median door to balloon (73 vs 64 min, P<0.001) time and were less likely to receive PCI (proportion difference=-23.6%, 95% CI -25.3 to -22.0). In the absence of PCI, elderly STEMI patients had a higher mortality within 30 days (elderly: HR 1.65, 95% CI 1.36 to 1.99, P<0.001; young: HR 1.10, 95% CI 0.79 to 1.54, P=0.573) and 1 year (elderly: HR 1.83, 95% CI 1.57 to 2.14, P<0.001; young: HR 1.41, 95% CI 1.09 to 1.83, P=0.009) of admission. The 1 year survival benefit of PCI started to decline after the age of 65 years. CONCLUSION Elderly STEMI patients were less likely to receive PCI and had longer door to balloon times. Survival benefit of PCI decreased after the age of 65 years, with the decline most evident from age 85 years onwards. The risks of PCI need to be weighed carefully against its benefits, especially in very elderly patients.
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Affiliation(s)
- Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Huili Zheng
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - Andrew Fu Wah Ho
- Emergency Medicine Residency Program, SingHealth Services, Singapore
| | - Win Wah
- Unit for Prehospital Emergency Care, Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Huay Cheem Tan
- Department of Cardiology, National University Heart Centre, Singapore
| | - Ling Li Foo
- National Registry of Diseases Office, Health Promotion Board, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore.,Health Services and Systems Research, Duke-NUS Medical School, Singapore
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Sappa R, Grillo MT, Cinquetti M, Prati G, Spedicato L, Nucifora G, Perkan A, Zanuttini D, Sinagra G, Proclemer A. Short and long-term outcome in very old patients with ST-elevation myocardial infarction after primary percutaneous coronary intervention. Int J Cardiol 2017; 249:112-118. [PMID: 28935461 DOI: 10.1016/j.ijcard.2017.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 07/04/2017] [Accepted: 09/08/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although octogenarians constitute a fast-growing portion of cardiovascular patients, few data are available on the outcome of patients aged ≥85 years with ST-Elevation Myocardial Infarction (STEMI). METHODS AND RESULTS We analyzed 126 consecutive patients aged ≥85 years (age 88±2 years) with STEMI, undergoing primary percutaneous coronary intervention (pPCI) within 12 hours from symptoms onset. Long-term follow-up (median 898 days) was obtained for the 102 patients surviving the index-hospitalization. In-hospital mortality rate was 19%. Nonagenarians, diabetes mellitus, severe left ventricular systolic dysfunction and intra-aortic balloon pumping were significantly and independently correlated to in-hospital mortality at the multivariate analysis. A low rate of complications was detected. Among patients surviving the index hospitalization, 32 (31%) patients died during follow-up. 55 patients (54%) had re-hospitalization due to cardiovascular causes. The univariate analysis identified chronic renal failure, Killip class ≥ 3, TIMI Risk Score >8 and very high risk of bleeding as predictors of long-term overall mortality. At the multivariate analysis only chronic renal failure and very high risk of bleeding were significantly and independently correlated to long-term all-cause mortality. Renal function and anterior myocardial infarction were significantly and independently associated with the combined end-point of cardiac mortality and re-hospitalization due to cardiovascular disease at the multivariate analysis. CONCLUSIONS PPCI in patients ≥85 years old is relatively safe. In this population, pPCI is associated with a good long-term survival, although still worse than in younger patients, despite a considerable incidence of re-hospitalization due to cardiovascular events.
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Affiliation(s)
- Roberta Sappa
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy.
| | - Maria Teresa Grillo
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Martino Cinquetti
- Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Giulio Prati
- Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy
| | - Leonardo Spedicato
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Gaetano Nucifora
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Andrea Perkan
- Cardiovascular Department, "Azienda Sanitaria Universitaria Integrata" of Trieste, Italy
| | - Davide Zanuttini
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
| | - Gianfranco Sinagra
- Postgraduate School of Cardiovascular Sciences, University of Trieste, Trieste, Italy; Cardiovascular Department, "Azienda Sanitaria Universitaria Integrata" of Trieste, Italy
| | - Alessandro Proclemer
- Cardiothoracic Department, "Azienda Sanitaria Universitaria Integrata" of Udine, Italy
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Impact of age on short- and long-term mortality of patients with ST-elevation myocardial infarction in the VIENNA STEMI network. Wien Klin Wochenschr 2017; 130:172-181. [DOI: 10.1007/s00508-017-1250-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Liu H, Li G, Zhao W, Hu Y. Inhibition of MiR-92a May Protect Endothelial Cells After Acute Myocardial Infarction in Rats: Role of KLF2/4. Med Sci Monit 2016; 22:2451-62. [PMID: 27411964 PMCID: PMC4957625 DOI: 10.12659/msm.897266] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background This study was designed to investigate the effects of microRNA-92 (miR-92), Kruppel-like factor 2 (KLF2), and Kruppel-like factor 4 (KLF4) on endothelial injury after acute myocardial infarction (AMI). Material/Methods Blood samples were collected from 50 AMI patients for detection of cardiac troponin I (cTnI), heart-type fatty acid-binding protein (H-FABP), and von Willebrand factor (vWF). The Sprague-Dawley rat models of AMI (n=30) were established by ligating their left anterior descending coronary artery. The cardiac markers of AMI patients and rat models were analyzed with enzyme-linked immunosorbent assay and immunohistochemistry. Human umbilical vein endothelial cells were processed into 5 groups: control, negative control, miR-92a inhibitors, miR-92a inhibitors + KLF2 small interfering RNA (siRNA), and miR-92a inhibitors + KLF4 siRNA. Cell proliferation and apoptosis were detected using MTT assay and flow cytometry. RT-PCR and Western blot were conducted to analyze KLF2 and KLF4 expressions. Results AMI patients exhibited significantly higher expression of both endothelial injury markers (e.g., cTnI, H-FABP, vWF) and miR-92a in blood samples, when compared with controls (P<0.05). Model rats also had similar expressional tendencies, along with lower KLF2 and KLF4 expressions (P<0.05). Further, it could be observed in cellular experiments that treatment of miR-92a mimics can further upregulate endothelial injury markers, and miR-92a and both KLF2 and KLF4 were downregulated by miR-92a mimics (all, P<0.05). Also, the luciferase activity assay confirmed the direct binding of miR-92a to 3′ UTR of KLF2/4. Conclusions MiR-92a was involved in the endothelial injury process after AMI and was able to suppress KLF2 and KLF4 expression.
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Affiliation(s)
- Hongxia Liu
- Department of Clinical Laboratory Medicine, The Central Hospital of Nanyang, Nanyang, Henan, China (mainland)
| | - Guofen Li
- Cell Morphology Inspection of Clinical Laboratory Medicine, The Central Hospital of Nanyang, Nanyang, Henan, China (mainland)
| | - Wenxue Zhao
- Department of Cardiology, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China (mainland)
| | - Yibo Hu
- Department of Cardiopulmonary Exercise Testing, The Central Hospital of Nanyang, Nanyang, Henan, China (mainland)
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Saraf AA, Bell SP. Risk Stratification for Older Adults with Myocardial Infarction. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0493-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Nicolau JC, Franci A, Barbosa CJD, Baracioli LM, Franken M, Furtado RH, Giraldez RR, Ganem F, Lima FG, Menezes FR, Arantes FB, Ramires JA, Filho RK, Giugliano RP. Influence of proven oral therapies in the very old with acute coronary syndromes: A 15year experience. Int J Cardiol 2015; 198:213-5. [DOI: 10.1016/j.ijcard.2015.06.119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/26/2015] [Indexed: 11/30/2022]
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Gray D, Johnson KD, Watts B. Lost In Translation? Addressing Barriers in the Application of Industrial Process Improvement Methodologies to Health Care. Jt Comm J Qual Patient Saf 2014; 40:514-21. [DOI: 10.1016/s1553-7250(14)40066-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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10
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Showkathali R, Boston-Griffiths E, Parker M, Davies JR, Clesham GJ, Sayer JW, Kelly PA, Aggarwal RK. Should primary percutaneous coronary intervention be the routine reperfusion strategy in octogenarians presenting with ST elevation myocardial infarction? J Cardiovasc Med (Hagerstown) 2014; 15:53-9. [PMID: 24500237 DOI: 10.2459/jcm.0b013e3283649978] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIM Very few randomized trials have analysed the outcome of primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI) in very elderly patients (≥80 years). An observational study was performed to evaluate the outcome of PPCI in patients of at least 80 years of age who were admitted to our unit. METHODS We included all patients undergoing PPCI in our unit from September 2009 to November 2011. RESULTS Of the 1471 patients who underwent PPCI during the study period, 236 (16%) were at least 80 years of age. The mean age was 85 ± 4 years (range 80-99 years, median 85 years). There was a significant difference in in-hospital mortality [14.4 vs. 2.9%, odds ratio (OR) 5.6, 95% confidence interval (CI) 3.4-9.2, P <0.0001], 30-day mortality (20.3 vs. 4%, OR 6.2, 95% CI 4.0-9.5, P <0.0001), 1-year mortality (28.8 vs. 6.2%, OR 6.1, 95% CI 4.2-8.8, P <0.0001), 30-day stent thrombosis (1.7 vs. 0.4%, OR 4.2, 95% CI 1.1-15.9, P = 0.04) and non-coronary artery bypass grafting major bleed (5.9 vs. 3%, OR 2, 95% CI 1.1-3.8, P = 0.03) between patients aged at least 80 years and those less than 80 years. CONCLUSION The mortality in our patients of at least 80 years was similar to the previously published data, despite the advances in PPCI procedures. Considering the increasing number of octogenarian patients with STEMI at the present time, there is a need for a randomized trial to compare the different treatment strategies for STEMI.
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Affiliation(s)
- Refai Showkathali
- aDepartment of Cardiology, The Essex Cardiothoracic Centre, Essex bAnglia Ruskin University, Chelmsford, UK
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Chanti-Ketterl M, Pathak EB, Andel R, Mortimer JA. Dementia: a barrier to receiving percutaneous coronary intervention for elderly patients with ST-elevated myocardial infarction. Int J Geriatr Psychiatry 2014; 29:906-14. [PMID: 24523068 DOI: 10.1002/gps.4078] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/19/2013] [Accepted: 12/20/2013] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Percutaneous coronary intervention (PCI) is the first line of treatment for ST-elevated myocardial infarction (STEMI). This study evaluates the role of dementia in diagnostic cardiac catheterization (to receive PCI) in STEMI patients ≥65 years old admitted to high annual volume PCI hospitals. METHODS Participants were registered in Florida's comprehensive inpatient surveillance system for the years 2006-2007 with principal diagnosis of STEMI. Dementia was defined using ICD-9 codes for presenile, senile, and Alzheimer's type dementia. RESULTS Data from 8331 STEMI patients were used. Of these, 77.2% were catheterized, 67.2% received PCI, and 9.3% had coronary artery bypass graft (CABG). The mean age of the cohort was 76.3 years (SD 7.8 years.); with 43.3% female, 83.4% white, 4.6% black, and 12% Hispanic/other. Of the 248 (3%) patients with dementia, 42% were catheterized. After adjustment for age, gender, and race/ethnicity, patients with dementia were less likely to be catheterized (RR 0.30, 95% CI 0.30-0.50) than non-demented patients. However, among patients who were catheterized, there was no difference in the use of PCI or CABG for patients with versus without dementia (p = 0.56). Of those with dementia, being older and arriving to the hospital in the afternoon were associated with lower likelihood of being catheterized (RR 0.08, 95% CI 0.02-0.28, and RR 0.30, 95% CI 0.10-0.88, respectively). However, having hyperlipidemia increased the probability of catheterization (RR 3.60, 95% CI 1.86-6.98). CONCLUSION ST-elevated myocardial infarction patients with dementia were much less likely to receive diagnostic cardiac catheterization, thereby limiting the possibility for receiving optimal care including PCI or CABG.
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Caretta G, Passamonti E, Pedroni PN, Fadin BM, Galeazzi GL, Pirelli S. Outcomes and predictors of mortality among octogenarians and older with ST-segment elevation myocardial infarction treated with primary coronary angioplasty. Clin Cardiol 2014; 37:523-9. [PMID: 25100028 DOI: 10.1002/clc.22313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 06/11/2014] [Accepted: 06/15/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Elderly patients are at high risk of mortality when they present with ST-elevation myocardial infarction (STEMI). However, few data exist about prognostic factors in this sub-group when treated with primary percutaneous coronary intervention (pPCI). HYPOTHESIS To assess outcome and predictors of mortality among patients aged >80 years treated with pPCI. METHODS We evaluated 139 consecutive patients (age 85.1 ± 3.9 years, 43.2% males) who underwent pPCI for STEMI. RESULTS Male patients were younger and were more likely to have a history of coronary artery disease. Overall 30-day and 1-year mortality rates were 20.9% and 28.1%, respectively. Thrombolysis in Myocardial Infarction (TIMI) flow 3 was achieved in 82% of patients. There was a pPCI success rate in male patients. At univariable analysis, older age, diabetes mellitus, Killip class >III, left ventricular ejection fraction (LVEF) <40%, no use of stent, failure of pPCI, systolic blood pressure (SBP) <100 mm Hg, and infarct-related artery (left anterior descending vs others) were associated with higher 1-year mortality. Multivariate analysis identified LVEF <40% (hazard ratio: [HR] = 3.70; 95% confidence interval [CI]: 1.30-7.87; P = 0.0001), age (1-year step, HR: 1.13; 95% CI: 1.04-1.23; P = 0.007), failure of pPCI (HR: 2.93; 95% CI: 1.44-5.98; P = 0.0001), Killip class ≥III (HR: 2.29; 95% CI: 1.03-5.4; P = 0.04) and SBP <100 mm Hg (HR: 2.64; 95% CI: 1.22-5.19; P = 0.01) to be independently associated with increased 1-year mortality. CONCLUSIONS Our data show that elderly patients with STEMI have a high risk of mortality, which is particularly high in the first 30 days. Older age, LVEF <40% at admission, hemodynamic instability (higher Killip class or low SBP), and postinterventional TIMI flow <3 were independent predictors of mortality in our population.
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Affiliation(s)
- Giorgio Caretta
- Department of Cardiology, A.O. "Istituti Ospitalieri" di Cremona, Cremona, Italy
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The Effects and Mechanism of miR-92a and miR-126 on Myocardial Apoptosis in Mouse Ischemia-Reperfusion Model. Cell Biochem Biophys 2014; 70:1901-6. [DOI: 10.1007/s12013-014-0149-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Donahue M, Briguori C. Coronary artery stenting in elderly patients: where are we now. Interv Cardiol 2014. [DOI: 10.2217/ica.14.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Martin AC, Dumas F, Spaulding C, Manzo-Silberman S. Management and decision-making process leading to coronary angiography and revascularization in octogenarians with coronary artery disease: Insights from a large single-center registry. Geriatr Gerontol Int 2014; 15:544-52. [PMID: 24852008 DOI: 10.1111/ggi.12308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2014] [Indexed: 11/30/2022]
Abstract
AIMS Cardiovascular diseases remain the most common cause of death in older adults. Guidelines state that advanced age alone should not limit the use of invasive therapy. However, coronary angiograms and subsequent revascularization are often not carried out in octogenarians. The benefit/risk balance of an invasive strategy and the decision-making process are not clearly defined. The aim of the present study was to assess the decision-making process, and the in-hospital and long-term mortality based on the clinical presentation, the diagnostic approach (coronary angiogram or conservative) and the therapeutic management (revascularization or not). METHODS The present study was a single-center retrospective analysis. RESULTS A total of 522 patients aged ≥80 years, with a diagnosis of coronary disease were included from 2003 to 2009. The mean age was 82 ± 2.6 years. A total of 195 of 522 (37%) presented with a ST segment elevation myocardial infarction (STEMI). A coronary angiogram was carried out in 316 patients (60.5%) and 71% were treated by percutaneous coronary revascularization. A total of 39.5% were considered ineligible for a coronary angiogram due to cardiological reasons or comorbidities. Excluding cardiogenic shock, overall in-hospital mortality was 4.9%. Clinical presentation strongly influenced both in-hospital and 6-month mortality rates (cardiogenic shock 20% and 28.7%, stable angina 1% and 4.1%, respectively, P < 0.001). Long-term mortality was reduced in the coronary angiography arm compared with the conservative group (14.3% vs 20.9%, P = 0.04) whether or not revascularization was carried out. CONCLUSION In the present study, in octogenarians, long-term mortality was lower in the group of patients who underwent a coronary angiogram, regardless of revascularization. The selection process for coronary angiography and angioplasty was mostly influenced by the existence of age-associated comorbidities. Risk prediction models are required to reduce age-dependent biases.
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Solhpour A, Chang KW, Balan P, Cai C, Sdringola S, Denktas AE, Smalling RW, Anderson HV. Comparison of outcomes for patients ≥75 years of age treated with pre-hospital reduced-dose fibrinolysis followed by percutaneous coronary intervention versus percutaneous coronary intervention alone for treatment of ST-elevation myocardial infarction. Am J Cardiol 2014; 113:60-3. [PMID: 24207074 DOI: 10.1016/j.amjcard.2013.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 10/26/2022]
Abstract
A coordinated system of care for patients with ST-segment elevation myocardial infarctions that includes prehospital administration of reduced-dose fibrinolytic agents coupled with urgent percutaneous coronary intervention (PCI), termed FAST-PCI, has been shown to be at least as effective as primary PCI (PPCI) alone. However, this reduced-dose fibrinolytic strategy could be associated with increased bleeding risk, especially in elderly patients. The purpose of this study was to examine 30-day outcomes in patients aged ≥75 years with ST-segment elevation myocardial infarctions treated with either strategy. Data from 120 patients aged ≥75 years treated with FAST-PCI were compared with those of 94 patients aged ≥75 years treated with PPCI. The primary comparator was mortality at 30 days. Stroke, reinfarction, and major bleeding were also compared. The groups were well matched for age, cardiac risk factors, and ischemic times. At 30 days, mortality was lower with FAST-PCI than with PPCI (4.2% vs 18.1%, p <0.01). Rates of stroke, reinfarction, and major bleeding (4% vs 2%) were similar in the 2 groups. The FAST-PCI cohort had lower rates of cardiogenic shock on hospital arrival (15% vs 26%, p = 0.05) and completely occluded infarct arteries (Thrombolysis In Myocardial Infarction [TIMI] grade 0 flow, 35% vs 61%, p <0.01). In conclusion, for patients aged ≥75 years with ST-segment elevation myocardial infarctions, a FAST-PCI strategy in a coordinated system of care was associated with reduced 30-day mortality, earlier infarct artery patency, and lower incidence of cardiogenic shock at arrival compared with PPCI, without apparent bleeding, stroke, or reinfarction penalties.
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Christiansen EC, Wickstrom KK, Henry TD, Garberich RF, Rutten-Ramos SC, Larson DM, Grey EZ, Thiessen NL, Hauser RG, Newell MC. Comparison of functional recovery following percutaneous coronary intervention for ST elevation myocardial infarction in three age groups (<70, 70 to 79, and ≥80 years). Am J Cardiol 2013; 112:330-5. [PMID: 23642505 DOI: 10.1016/j.amjcard.2013.03.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 03/16/2013] [Accepted: 03/16/2013] [Indexed: 11/28/2022]
Abstract
Functional outcomes of elderly patients ≥80 years who undergo percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) are unknown. Registry data indicate that up to 55% of elderly patients with STEMI do not receive reperfusion therapy despite a suggested mortality benefit, and only limited data are available regarding outcomes in elderly patients treated with primary PCI. Therefore, prospective data from a regional STEMI transfer program were analyzed to determine major adverse cardiac events, length of stay, and discharge status of consecutive patients with STEMI ≥80 years from March 2003 to November 2006. Of the 1,323 consecutive patients with STEMI treated in this regional STEMI system from March 2003 to November 2006, 199 (15.0%) were ≥80 years old. In-hospital mortality in elderly patients was 11.6%, with a 1-year mortality rate of 25.6%. Of the 166 patients with age ≥80 who lived independently or in assisted living before hospital admission and survived, 150 (90.4%) were discharged to a similar living situation or projected to such a living situation after temporary nursing home care. The median length of hospital stay was 4 days for these patients. In conclusion, elderly patients with age ≥80 receiving PCI for STEMI in a regional STEMI program have short hospital stays and excellent functional recovery on the basis of a very high rate of return to a similar previous living situation.
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Affiliation(s)
- Ellen C Christiansen
- Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, Minneapolis, MN, USA
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Karwowski J, Bęćkowski M, Szwed H, Ciszewski A. Acute coronary syndrome in a 100-year-old woman treated successfully with primary percutaneous coronary angioplasty. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2013; 9:179-83. [PMID: 24570714 PMCID: PMC3915969 DOI: 10.5114/pwki.2013.35456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/15/2013] [Accepted: 05/09/2013] [Indexed: 11/17/2022] Open
Abstract
We present a case of a 100-year-old woman living alone with ST-elevation myocardial infarction acute coronary syndrome of the infero-lateral wall treated with percutaneous coronary intervention. Coronary angiography revealed critical 99% stenosis in the marginal branch of the circumflex artery and insignificant lesions in other arteries. Two bare metal stents were implanted successfully in the same session. The patient was discharged home in good general condition, able to live and function independently.
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Affiliation(s)
- Jarosław Karwowski
- 2 Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Maciej Bęćkowski
- 2 Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Hanna Szwed
- 2 Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Andrzej Ciszewski
- Department of Invasive Cardiology, Institute of Cardiology, Warsaw, Poland
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Juárez-Herrera Ú, Jerjes-Sánchez C. Risk factors, therapeutic approaches, and in-hospital outcomes in Mexicans with ST-elevation acute myocardial infarction: the RENASICA II multicenter registry. Clin Cardiol 2013; 36:241-8. [PMID: 23494467 DOI: 10.1002/clc.22107] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 01/26/2013] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Ischemic heart disease is a growing health problem in Latin America. We aimed to analyze risk factors, acute management, and short-term outcome of Mexicans with ST-elevation myocardial infarction (STEMI). HYPOTHESIS Modifiable risk factors are associated with the occurrence of STEMI in Mexicans, and potentially preventable acute complications are responsible for most short-term deaths. METHODS Among 8600 patients enrolled in Registro Nacional de los Síndromes Coronarios Agudos II (RENASICA II) with a suspected acute coronary syndrome, we analyzed 4555 patients (56%; age 21-100 y) with confirmed STEMI who presented within 24 hours from symptoms' onset. RESULTS Smoking (66%), hypertension (50%), and diabetes (43%) were the main risk factors. Most patients (74%) presented with Killip class I (class IV in 4%). Anterior-located STEMI occurred in 56% of cases, and posterior-inferior in 40% of cases. Significant Q waves were present in 43%, right bundle branch block in 7%, left bundle branch block in 5%, first-degree atrioventricular block in 2%, and high-degree atrioventricular block in 2%. A total of 1685 (37%) patients received fibrinolytic therapy (streptokinase, 82%; alteplase, 17%; tenecteplase, 1%), with 31% of patients receiving therapy in <2 hours, 36% in 2-4 hours, 19% in 4-6 hours, and 15% in >6 hours. Thirty percent of patients received either percutaneous coronary intervention or coronary artery bypass grafting during hospitalization. Major adverse cardiovascular events were recurrent ischemia (12%), reinfarction (4%), cardiogenic shock (4%), and stroke (1%). The main predictors of 30-day mortality (10%) in multivariate analysis were age ≥65 years (odds ratio [OR]: 2.47, 95% confidence interval [CI]: 1.94-3.13), Killip class IV (OR: 10.60, 95% CI: 6.09-18.40), and cardiogenic shock (OR: 18.76, 95% CI: 10.60-33.20). CONCLUSIONS Largely modifiable risk factors and preventable short-term complications are responsible for most STEMI cases and outcomes in this Mexican population.
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Affiliation(s)
- Úrsulo Juárez-Herrera
- Coronary Unit, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico.
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Jiménez-Candil J, Díaz-Castro Ó, Barrabés JA, García de la Villa B, Bodí Peris V, López Palop R, Fernández-Ortiz A, Martínez-Sellés M. Actualización en cardiopatía isquémica y cuidados críticos cardiológicos. Rev Esp Cardiol 2013. [DOI: 10.1016/j.recesp.2012.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Jiménez-Candil J, Díaz-Castro Ó, Barrabés JA, García de la Villa B, Bodí Peris V, López Palop R, Fernández-Ortiz A, Martínez-Sellés M. Update on ischemic heart disease and critical care cardiology. ACTA ACUST UNITED AC 2013; 66:198-204. [PMID: 24775454 DOI: 10.1016/j.rec.2012.10.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 10/23/2012] [Indexed: 11/19/2022]
Abstract
This article summarizes the main developments reported during the year 2012 concerning ischemic heart disease, together with the most relevant innovations in the management of acute cardiac patients.
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Affiliation(s)
- Javier Jiménez-Candil
- Servicio de Cardiología, IBSAL-Hospital Universitario de Salamanca, Universidad de Salamanca, Salamanca, Spain.
| | - Óscar Díaz-Castro
- Servicio de Cardiología, Complejo Hospitalario Universitario do Mexoeiro, Vigo, Pontevedra, Spain
| | - José A Barrabés
- Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, Spain
| | | | - Vicente Bodí Peris
- Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, INCLIVA, Valencia, Spain
| | - Ramón López Palop
- Servicio de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain
| | - Antonio Fernández-Ortiz
- Servicio de Cardiología, Hospital Clínico San Carlos, Universidad Complutense de Madrid, Madrid, Spain
| | - Manuel Martínez-Sellés
- Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Universidad Europea de Madrid, Madrid, Spain
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