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Starnecker F, Coughlan JJ, Jensen LO, Bär S, Kufner S, Brugaletta S, Räber L, Maeng M, Ortega-Paz L, Heg D, Laugwitz KL, Sabaté M, Windecker S, Kastrati A, Olesen KKW, Cassese S. Ten-year clinical outcomes after drug-eluting stents implantation according to clinical presentation-Insights from the DECADE cooperation. Eur J Clin Invest 2024:e14323. [PMID: 39351821 DOI: 10.1111/eci.14323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2024] [Accepted: 09/18/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND Investigations of very long-term outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) according to clinical presentation are scarce. Here, we investigated the 10-year clinical outcomes of patients undergoing DES-PCI according to clinical presentation. METHODS Patient-level data from five randomized trials with 10-year follow-up after DES-PCI were pooled. Patients were dichotomized into acute coronary syndrome (ACS) or chronic coronary syndrome (CCS) groups as per clinical presentation. The primary outcome was all-cause death. Secondary outcomes were cardiovascular death, myocardial infarction (MI), definite stent thrombosis (ST) and repeat revascularization involving the target lesion (TLR), target vessel (TVR) or non-target vessel (nTVR). RESULTS Of the 9700 patients included in this analysis, 4557 presented with ACS and 5143 with CCS. Compared with CCS patients, ACS patients had a higher risk of all-cause death and nTVR in the first year, but comparable risk thereafter. In addition, ACS patients had a higher risk of MI [adjusted hazard ratio 1.21, 95% confidence interval (1.04-1.41)] and definite ST [adjusted hazard ratio 1.48, 95% confidence interval (1.14-1.92)], while the risk of TLR and TVR was not significantly different up to 10-year follow-up. CONCLUSIONS Compared to CCS patients, ACS patients treated with PCI and DES implantation have an increased risk of all-cause death and repeat revascularization of remote vessels up to 1 year, with no significant differences thereafter and up to 10-year follow-up. ACS patients have a consistently higher risk of MI and definite ST. Whether these differences persist with current antithrombotic and secondary prevention therapies requires further investigation.
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Affiliation(s)
- Fabian Starnecker
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - J J Coughlan
- Cardiovascular Research Institute, Mater Private Network, Dublin, Ireland
| | | | - Sarah Bär
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sebastian Kufner
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
| | - Salvatore Brugaletta
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Lorenz Räber
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Luis Ortega-Paz
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Dik Heg
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Karl-Ludwig Laugwitz
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Manel Sabaté
- Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), CIBERCV CB16/11/00411, Madrid, Spain
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Adnan Kastrati
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | | | - Salvatore Cassese
- Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Munich, Germany
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Damluji AA, Bandeen-Roche K, Berkower C, Boyd CM, Al-Damluji MS, Cohen MG, Forman DE, Chaudhary R, Gerstenblith G, Walston JD, Resar JR, Moscucci M. Percutaneous Coronary Intervention in Older Patients With ST-Segment Elevation Myocardial Infarction and Cardiogenic Shock. J Am Coll Cardiol 2020; 73:1890-1900. [PMID: 30999991 DOI: 10.1016/j.jacc.2019.01.055] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/24/2019] [Accepted: 01/28/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Older adults ≥75 years of age carry an increased risk of mortality after ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock. OBJECTIVES The purpose of this study was to examine the use of percutaneous coronary intervention (PCI) in older adults with STEMI and shock and its influence on in-hospital mortality. METHODS We used a large publicly available all-payer inpatient health care database sponsored by the Agency for Healthcare Research and Quality between 1999 and 2013. The primary outcome was in-hospital mortality. The influence of PCI on in-hospital mortality was assessed by quintiles of propensity score (PS). RESULTS Of the 317,728 encounters with STEMI and shock in the United States, 111,901 (35%) were adults age ≥75 years. Of these, 53% were women and 83% were Caucasians. The median number of chronic conditions was 8 (interquartile range: 6 to 10). The diagnosis of STEMI and cardiogenic shock in older patients decreased significantly over time (proportion of older adults with STEMI and shock: 1999: 42% vs. 2013: 29%). Concomitantly, the rate of PCI utilization in older adults increased (1999: 27% vs. 2013: 56%, p < 0.001), with declining in-hospital mortality rates (1999: 64% vs. 2013: 46%; p < 0.001). Utilizing PS matching methods, PCI was associated with a lower risk of in-hospital mortality across quintiles of propensity score (Mantel-Haenszel odds ratio: 0.48; 95% confidence interval [CI]: 0.45 to 0.51). This reduction in hospital mortality risk was seen across the 4 different U.S. census bureau regions (adjusted odds ratio: Northeast: 0.41; 95% CI: 0.36 to 0.47; Midwest: 0.49; 95% CI: 0.42 to 0.57; South: 0.51; 95% CI: 0.46 to 0.56; West: 0.46; 95% CI: 0.41 to 0.53). CONCLUSIONS This large and contemporary analysis shows that utilization of PCI in older adults with STEMI and cardiogenic shock is increasing and paralleled by a substantial reduction in mortality. Although clinical judgment is critical, older adults should not be excluded from early revascularization based on age in the absence of absolute contraindications.
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Affiliation(s)
- Abdulla A Damluji
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland.
| | - Karen Bandeen-Roche
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Carol Berkower
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
| | - Mohammed S Al-Damluji
- Department of Internal Medicine, University of Connecticut Health Center, Farmington, Connecticut
| | | | - Daniel E Forman
- Geriatric Cardiology Section, University of Pittsburgh, Pittsburgh, Pennsylvania; Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Rahul Chaudhary
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland
| | - Gary Gerstenblith
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Jeremy D Walston
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Baltimore, Maryland
| | - Jon R Resar
- Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - Mauro Moscucci
- Sinai Hospital of Baltimore, LifeBridge Health Cardiovascular Institute, Baltimore, Maryland; University of Michigan Health System, Ann Arbor, Michigan.
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Elbadawi A, Elgendy IY, Ha LD, Saad M, Mahmoud K, Ogunbayo GO, Kumfa P, Rangasetty UC, Gilani S. National Trends of Percutaneous Coronary Intervention in Patients ≥70 Years of Age. Am J Cardiol 2019; 123:701-703. [PMID: 30595394 DOI: 10.1016/j.amjcard.2018.11.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/12/2018] [Accepted: 11/19/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Ayman Elbadawi
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt.
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, University of Florida, Gainesville, FL
| | - Le Dung Ha
- Department of Cardiovascular Medicine, New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY
| | - Marwan Saad
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock AR; Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt
| | - Karim Mahmoud
- Department of Internal Medicine, Houston Medical Center, Warner Robbins, GA
| | - Gbolahan O Ogunbayo
- Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY
| | - Paul Kumfa
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX
| | | | - Syed Gilani
- Division of Cardiovascular Medicine, University of Texas Medical Branch, Galveston, TX
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Biswas S, Andrianopoulos N, Papapostolou S, Noaman S, Duffy SJ, Lefkovits J, Brennan A, Walton A, Shaw JA, Ajani A, Clark DJ, Freeman M, Hiew C, Oqueli E, Reid CM, Stub D, Chan W. Does the subtype of acute coronary syndrome treated by percutaneous coronary intervention predict long-term clinical outcomes? EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2018; 4:318-327. [DOI: 10.1093/ehjqcco/qcy009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 03/20/2018] [Indexed: 11/13/2022]
Affiliation(s)
- Sinjini Biswas
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Nick Andrianopoulos
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stavroula Papapostolou
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Samer Noaman
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Stephen J Duffy
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Jeffrey Lefkovits
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Antony Walton
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - James A Shaw
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
| | - Andrew Ajani
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - David J Clark
- Department of Cardiology, Austin Health, Melbourne, Australia
| | - Melanie Freeman
- Department of Cardiology, Box Hill Hospital, Melbourne, Australia
| | - Chin Hiew
- Department of Cardiology, University Hospital Geelong, Geelong, Australia
| | - Ernesto Oqueli
- Department of Cardiology, Ballarat Health Services, Ballarat, Australia
- School of Medicine, Deakin University, Ballarat, Australia
| | - Christopher M Reid
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- School of Public Health, Curtin University, Perth, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - William Chan
- Department of Cardiovascular Medicine, The Alfred Hospital, Commercial Road, Melbourne, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
- Baker IDI Heart and Diabetes Institute, Melbourne, Australia
- Department of Medicine, Monash University, Melbourne, Australia
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5
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Alzahrani A, Ruddy TD. Stress myocardial perfusion imaging in the elderly. J Nucl Cardiol 2018; 25:72-74. [PMID: 27457524 DOI: 10.1007/s12350-016-0585-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 05/31/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Atif Alzahrani
- Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H1220, Ottawa, ON, K1Y 4W7, Canada
| | - Terrence D Ruddy
- Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H1220, Ottawa, ON, K1Y 4W7, Canada.
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Sahin M, Ocal L, Kalkan AK, Kilicgedik A, Kalkan ME, Teymen B, Arslantas U, Turkmen MM. In-Hospital and long term results of primary angioplasty and medical therapy in nonagenarian patients with acute myocardial infarction. J Cardiovasc Thorac Res 2017; 9:147-151. [PMID: 29118947 PMCID: PMC5670336 DOI: 10.15171/jcvtr.2017.25] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 09/16/2017] [Indexed: 11/25/2022] Open
Abstract
Introduction: Although percutaneous coronary intervention is an accepted "first-line" therapy in acute ST elevation myocardial infarction (STEMI) in general population, few data are available on the short- and long-term outcomes of very old patients (age >90 years). Our aim is to evaluate and compare the short and long-term outcomes after primary percutaneous coronary intervention (PPCI) or medical therapy in nonagenarian patients with STEMI.
Methods: We retrospectively identified patients older than 90 years old in our clinic, with acute STEMI who presented within 12 hours after symptoms onset, either underwent PPCI or medically treated. In hospital events and long-term results analyzed subsequently.
Results: From January 2005 to December 2014, 73 patients with STEMI either underwent PPCI (PPCI group n = 42) or had only medical treatment (Non-PPCI group n = 31). Mean age was 92.4 ± 3.1 (90-106). Patients were followed 26.5 ± 20.1 months. Recurrent myocardial infarction during hospitalization was not observed in both groups. In-hospital mortality, cerebrovascular events and acute renal failure rate were similar between two groups (respectively P = 0.797 and P = 1.000, P = 0.288), whereas arrhythmia was significantly higher in the PPCI group ( 0; 21.4%, P = 0.009). Results show re-infarction was similar in both groups (respectively 3.2%; 11.9%, P = 0.382) but mortality in long-term was significantly lower in the PPCI group (respectively 40.9%; 12.9%, P = 0.02).
Conclusion: In nonagenarian patients, with STEMI mortality is very high. Although; in-hospital events were similar, the long-term mortality rate was significantly lower in patients treated with PPCI.
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Affiliation(s)
- Muslum Sahin
- Kartal Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Lutfi Ocal
- Kartal Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ali Kemal Kalkan
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Alev Kilicgedik
- Kartal Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Emin Kalkan
- Kartal Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Burak Teymen
- Emsey Hospital, Department of Cardiology, Istanbul, Turkey
| | - Ugur Arslantas
- Kartal Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mehmet Muhsin Turkmen
- Kartal Kosuyolu Heart Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
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7
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Tisminetzky M, Erskine N, Chen HY, Gore J, Gurwitz J, Yarzebski J, Joffe S, Shaw P, Goldberg R. Changing Trends in, and Characteristics Associated with, Not Undergoing Cardiac Catheterization in Elderly Adults Hospitalized with ST-Segment Elevation Acute Myocardial Infarction. J Am Geriatr Soc 2015; 63:925-31. [PMID: 25940950 PMCID: PMC4439287 DOI: 10.1111/jgs.13399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To describe decade- long trends (1999-2009) in the rates of not undergoing cardiac catheterization and percutaneous coronary intervention (PCI) in individuals aged 65 and older presenting with an ST-segment elevation acute myocardial infarction (STEMI) and factors associated with not undergoing these procedures. DESIGN Observational population-based study. SETTING Worcester, Massachusetts, metropolitan area. PARTICIPANTS Individuals aged 65 and older hospitalized for an STEMI in six biennial periods between 1999 and 2009 at 11 central Massachusetts medical centers (N=960). MEASUREMENTS Analyses were conducted to examine the characteristics of people who did not undergo cardiac catheterization overall and stratified into two age strata (65-74, ≥75). RESULTS Between 1999 and 2009, dramatic declines (from 59.4% to 7.5%) were observed in the proportion of older adults who did not undergo cardiac catheterization at all greater Worcester hospitals. These declines were observed in individuals aged 65 to 74 (58.4-6.7%) and in those aged 75 and older (69.4-13.5%). The proportion of individuals not undergoing PCI after undergoing cardiac catheterization decreased from 36.6% in 1999 to 6.5% in 2009. Women, individuals with a prior MI, those with do-not-resuscitate orders, and those with various comorbidities were less likely to have undergone these procedures than comparison groups. CONCLUSION Older adults who develop an STEMI are increasingly likely to undergo cardiac catheterization and PCI, but several high-risk groups remain less likely to undergo these procedures.
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Affiliation(s)
- Mayra Tisminetzky
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Nathaniel Erskine
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Han-Yang Chen
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Joel Gore
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jerry Gurwitz
- Meyers Primary Care Institute, University of Massachusetts Medical School, Worcester, Massachusetts
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Samuel Joffe
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Peter Shaw
- Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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Edelman JJ, Tatoulis J, Hayward PA, Smith JA, Costa RJ, Vallely MP, Bannon PG. ANZSCTS Response to the Discussion Paper: Proposed Recommendations for Myocardial Revascularisation. Heart Lung Circ 2015; 24:646-8. [PMID: 25637251 DOI: 10.1016/j.hlc.2014.11.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 11/26/2014] [Indexed: 11/28/2022]
Affiliation(s)
- J J Edelman
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital; The Baird Institute; University of Sydney, Sydney, Australia
| | - J Tatoulis
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital; Department of Surgery, University of Melbourne
| | - P A Hayward
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Victorian Heart Centre, Epworth Hospital; Department of Cardiac Surgery, Austin Hospital; University of Melbourne, Melbourne, Australia
| | - J A Smith
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Department of Cardiothoracic Surgery, Monash Health and Department of Surgery (Monash Medical Centre), Monash University, Clayton, Victoria, Australia
| | - R J Costa
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Department of Cardiothoracic Surgery, Westmead Hospital, Sydney, Australia
| | - M P Vallely
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital; The Baird Institute; University of Sydney, Sydney, Australia
| | - P G Bannon
- Australian and New Zealand Society of Cardiac and Thoracic Surgeons, Sydney, Australia; Cardiothoracic Surgical Unit, Royal Prince Alfred Hospital; The Baird Institute; University of Sydney, Sydney, Australia.
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9
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Yi GY, Zhang XG, Zhang J, Wang X. Factors related to the use of reperfusion strategies in elderly patients with acute myocardial infarction. J Cardiothorac Surg 2014; 9:111. [PMID: 24947968 PMCID: PMC4104739 DOI: 10.1186/1749-8090-9-111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
Background About eighty percent of acute myocardial infarction (AMI) cases occur in the elderly, we aim to examine the use of reperfusion strategies in elderly patients (≥65 years) with AMI and to investigate the factors affecting the use of these strategies. Methods A total of 352 consecutive elderly patients (≥65 years) with ST-elevated AMI (STAMI) were admitted, they were divided into 2 groups based on reperfusion treatment (thrombolysis or percutaneous coronary intervention, PCI): reperfusion therapy group (n = 268) and non-reperfusion therapy group (n = 84). Demographic and medical data were collected for comparison. Odds ratios (OR) and 95% confidence interval (C.I.) were calculated directly from the estimated regression coefficients. Results About 76.1% of the elderly patients with AMI received reperfusion treatment (62.5% received PCI, and 13.6% received thrombolysis). Stepwise Logistic regression analysis revealed that a patient age ≥75 years (95% CI: 0.194 ~ 0.590, OR = 0.338, P = 0.000) and medical history of angina (95% CI: 0.281 ~ 0.928, OR = 0.501, P = 0.014) were determining factors for receiving less reperfusion therapy. Complications including right ventricular myocardial infarction (MI) (95% CI: 1.618 ~ 12.907, OR = 4.472, P = 0.003), unbearable symptoms (95% CI: 1.132 ~ 3.928, OR = 1.839, P = 0.021) and medical insurance (95% CI: 1.313 ~ 4.524, OR = 2.429, P = 0.004) were independent predictors of reperfusion therapy. The reperfusion therapy subset analysis revealed that intracranial hemorrhage (2.7% vs. 8.3%, P = 0.000), left ventricular ejection fraction (LVEF) <45% (13.2% vs. 29.2%, P = 0.019) and mortality rate within 1 year (2.7% vs. 6.3%, P = 0.045) were significantly decreased in the PCI group as compared with thrombolysis. Conclusion Elderly patients with a medical history of angina, right ventricular MI, unbearable symptoms and medical insurance are likely be recipients of reperfusion strategies.
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Affiliation(s)
| | | | | | - Xian Wang
- Department of Cardiology, Beijing military general hospital, No, 5 Nan Men Cang Dongcheng Distrct, 100700 Beijing, China.
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10
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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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11
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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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12
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Seco M, Edelman JJB, Forrest P, Ng M, Wilson MK, Fraser J, Bannon PG, Vallely MP. Geriatric cardiac surgery: chronology vs. biology. Heart Lung Circ 2014; 23:794-801. [PMID: 24851829 DOI: 10.1016/j.hlc.2014.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 03/14/2014] [Accepted: 04/04/2014] [Indexed: 01/25/2023]
Abstract
Cardiac surgery is increasingly performed in elderly patients, and whilst the incidence of common risk factors associated with poorer outcome increases with age, recent studies suggest that outcomes in this population may be better than is widely appreciated. As such, in this review we have examined the current evidence for common cardiac surgical procedures in patients aged over 70 years. Coronary artery bypass grafting (CABG) in the elderly has similar early safety to percutaneous intervention, though repeat revascularisation is lower. Totally avoiding instrumentation of the ascending aorta with off-pump techniques may also reduce the incidence of neurological injury. Aortic valve replacement (AVR) significantly improves quality of life and provides excellent short- and long-term outcomes. Combined AVR and CABG carries higher risk but late survival is still excellent. Mini-sternotomy AVR in the elderly can provide comparable survival to full-sternotomy AVR. More accurate risk stratification systems are needed to appropriately select patients for transcatheter aortic valve implantation. Mitral valve repair is superior to replacement in the elderly, although choosing the most effective method is important for achieving maximal quality of life. Minimally-invasive mitral valve surgery in the elderly has similar postoperative outcomes to sternotomy-based surgery, but reduces hospital length of stay and return to activity. In operative candidates, surgical repair is superior to percutaneous repair. Current evidence indicates that advanced age alone is not a predictor of mortality or morbidity in cardiac surgery. Thus surgery should not be overlooked or denied to the elderly solely on the basis of their "chronological age", without considering the patient's true "biological age".
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Affiliation(s)
- Michael Seco
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - J James B Edelman
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Paul Forrest
- Sydney Medical School, The University of Sydney, Sydney, Australia; Department of Anaesthetics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Martin Ng
- Sydney Medical School, The University of Sydney, Sydney, Australia; Cardiology Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael K Wilson
- The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia
| | - John Fraser
- Critical Care Research Group, The Prince Charles Hospital, The University of Queensland
| | - Paul G Bannon
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia
| | - Michael P Vallely
- Sydney Medical School, The University of Sydney, Sydney, Australia; The Baird Institute of Applied Heart & Lung Surgical Research, Sydney, Australia; Cardiothoracic Surgery Unit, Royal Prince Alfred Hospital, Sydney, Australia; Australian School of Advanced Medicine, Macquarie University, Sydney, Australia.
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13
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Khanal S. Retrospective multicenter observational study of the interventional management of coronary disease in the very elderly: The NINETY. Indian Heart J 2014. [PMCID: PMC3946443 DOI: 10.1016/j.ihj.2013.12.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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14
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Anaortic Off-Pump Coronary Artery Bypass Grafting in the Elderly and Very Elderly. Heart Lung Circ 2013; 22:989-95. [DOI: 10.1016/j.hlc.2013.05.650] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 05/13/2013] [Accepted: 05/30/2013] [Indexed: 11/19/2022]
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15
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Lazzeri C, Valente S, Chiostri M, Attanà P, Picariello C, Gensini GF. Trends in mortality rates in elderly ST elevation myocardial infarction patients submitted to primary percutaneous coronary intervention: A 7-year single-center experience. Geriatr Gerontol Int 2012; 13:711-7. [DOI: 10.1111/ggi.12005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2012] [Indexed: 12/22/2022]
Affiliation(s)
- Chiara Lazzeri
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Serafina Valente
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Marco Chiostri
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Paola Attanà
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Claudio Picariello
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
| | - Gian Franco Gensini
- Intensive Cardiac Coronary Unit; Heart and Vessel Department; Teaching Hospital Careggi; Florence; Italy
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16
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Perrone-Filardi P, Cuocolo A, Dellegrottaglie S. Myocardial perfusion imaging in very elderly patients with suspected coronary artery disease: never too late! J Nucl Cardiol 2012; 19:224-6. [PMID: 22203448 DOI: 10.1007/s12350-011-9499-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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