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De Servi S, Landi A, Savonitto S, Morici N, De Luca L, Montalto C, Crimi G, De Rosa R, De Luca G. Antiplatelet Strategies for Older Patients with Acute Coronary Syndromes: Finding Directions in a Low-Evidence Field. J Clin Med 2023; 12:2082. [PMID: 36902869 PMCID: PMC10003933 DOI: 10.3390/jcm12052082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/23/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
Patients ≥ 75 years of age account for about one third of hospitalizations for acute coronary syndromes (ACS). Since the latest European Society of Cardiology guidelines recommend that older ACS patients use the same diagnostic and interventional strategies used by the younger ones, most elderly patients are currently treated invasively. Therefore, an appropriate dual antiplatelet therapy (DAPT) is indicated as part of the secondary prevention strategy to be implemented in such patients. The choice of the composition and duration of DAPT should be tailored on an individual basis, after careful assessment of the thrombotic and bleeding risk of each patient. Advanced age is a main risk factor for bleeding. Recent data show that in patients of high bleeding risk short DAPT (1 to 3 months) is associated with decreased bleeding complications and similar thrombotic events, as compared to standard 12-month DAPT. Clopidogrel seems the preferable P2Y12 inhibitor, due to a better safety profile than ticagrelor. When the bleeding risk is associated with a high thrombotic risk (a circumstance present in about two thirds of older ACS patients) it is important to tailor the treatment by taking into account the fact that the thrombotic risk is high during the first months after the index event and then wanes gradually over time, whereas the bleeding risk remains constant. Under these circumstances, a de-escalation strategy seems reasonable, starting with DAPT that includes aspirin and low-dose prasugrel (a more potent and reliable P2Y12 inhibitor than clopidogrel) then switching after 2-3 months to DAPT with aspirin and clopidogrel for up to 12 months.
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Affiliation(s)
- Stefano De Servi
- Department of Molecular Medicine, University of Pavia Medical School, 27100 Pavia, Italy
| | - Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | | | - Nuccia Morici
- IRCCS S. Maria Nascente—Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Leonardo De Luca
- Department of Cardiovascular Sciences, A.O. San Camillo-Forlanini, 00152 Roma, Italy
| | - Claudio Montalto
- Interventional Cardiology, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
- Clinical and Interventional Cardiology, Istituto Clinico Sant’Ambrogio, Gruppo San Donato, 20122 Milan, Italy
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS, Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Roberta De Rosa
- University Hospital San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy
- Goethe University Hospital Frankfurt, 60528 Frankfurt am Main, Germany
| | - Giuseppe De Luca
- Division of Cardiology, AOU “Policlinico G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, 98039 Messina, Italy
- Division of Cardiology, Nuovo Galeazzi-Sant’Ambrogio Hospital, 20161 Milan, Italy
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Marino M, Digiacomo S, Cacucci M, Catanoso A, Valentini P, Landolina M. Complete Percutaneous Revascularization in Patients Aged ≥85 Years With Acute Coronary Syndrome and Multivessel Coronary Artery Disease. Am J Cardiol 2022; 180:10-16. [PMID: 35906125 DOI: 10.1016/j.amjcard.2022.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 06/18/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022]
Abstract
Multivessel coronary disease is frequent in older patients who underwent coronary angiography for acute coronary syndrome. Whether a complete revascularization or a culprit-only approach is preferable in these patients is still debated. We included consecutive patients aged ≥85 years, presenting with acute coronary syndrome and showing multivessel coronary disease at coronary angiography. Patients were grouped according to complete (residual SYNTAX score [RSS] 0 to 8) or incomplete (RSS >8) revascularization. Primary end point was the rate of major adverse cardiovascular events (MACEs, the composite of cardiovascular death, re-myocardial infarction [re-MI], clinically driven percutaneous coronary intervention, and rehospitalization because of cardiac disease) at 2 years follow-up. A total of 166 patients met the criteria for enrollment; 108 patients had a final RSS 0 to 8 (complete revascularization) and 58 patients had a final RSS >8 (incomplete revascularization). The rate of MACE was reduced in patients who underwent complete revascularization (35.2% vs 51.7%, p = 0.039, adjusted hazard ratio 0.60, 95% confidence interval 0.37 to 0.98, p = 0.04), a difference mainly driven by a reduction in re-MI (8.3% vs 19.0%, p = 0.045), clinically driven percutaneous coronary intervention (2.8% vs 19.0%, p <0.001), and rehospitalization for cardiac disease (9.3% vs 24.1%, p = 0.009). Other independent predictors of MACE were active malignancy, previous MI, left ventricle ejection fraction <35% (increasing risk of events), and radial access (reducing risk of events). In conclusion, in patients aged ≥85 years, a complete revascularization is associated with a better prognosis, especially in terms of nonfatal events.
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Affiliation(s)
| | - Simonluca Digiacomo
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Policlinico San Marco, Zingonia, Italy
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Oh S, Jeong MH, Cho KH, Kim MC, Sim DS, Hong YJ, Kim JH, Ahn Y. Outcomes of Nonagenarians with Acute Myocardial Infarction with or without Coronary Intervention. J Clin Med 2022; 11:jcm11061593. [PMID: 35329920 PMCID: PMC8955178 DOI: 10.3390/jcm11061593] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/05/2022] [Accepted: 03/11/2022] [Indexed: 02/04/2023] Open
Abstract
Percutaneous coronary intervention (PCI) is the mainstay treatment of acute myocardial infarction (AMI); however, many clinicians are reluctant to perform PCI in the elderly population. This study aimed to compare the clinical outcomes of PCI versus medical therapy in nonagenarian Korean patients with AMI. We compared the clinical outcomes of nonagenarian patients with AMI with or without PCI. From the pooled data, based on a series of Korean AMI registries during 2005−2020, 467 consecutive patients were selected and categorized into two groups: the PCI and no-PCI groups. The primary endpoint was 1-year major adverse cardiac event (MACE), a composite of all-cause death, non-fatal myocardial infarction, and any revascularization. Among the 467 participants, 68.5% received PCI. The PCI group had lower proportions of Killip classes III-IV, previous heart failure, and left ventricular ejection fraction <40%, but had higher proportions of all prescribed medications and STEMI diagnosis. The 1-year MACE and all-cause death were higher in the no-PCI group, although partially attenuated post-IPTW. Our study showed that nonagenarian patients with AMI undergoing PCI had better clinical outcomes than those without PCI. Nonetheless, further investigation is needed in the future to elucidate whether PCI is beneficial for this population.
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Affiliation(s)
- Seok Oh
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
- Correspondence: ; Tel.: +82-10-2665-6243
| | - Kyung Hoon Cho
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
| | - Min Chul Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Doo Sun Sim
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Young Joon Hong
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Ju Han Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
| | - Youngkeun Ahn
- Department of Cardiology, Chonnam National University Hospital, Gwangju 61469, Korea; (S.O.); (K.H.C.); (M.C.K.); (D.S.S.); (Y.J.H.); (J.H.K.); (Y.A.)
- Department of Cardiology, Chonnam National University Medical School, Hwasun 58128, Korea
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NSTEMI: Auch ältere Patienten profitieren vom invasiven Vorgehen. Dtsch Med Wochenschr 2021. [DOI: 10.1055/a-1267-3806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Siddiqui MU, Chiuzan C, Siddiqui MD, Ali SS, Naeem Z, Islam S. Temporal Pattern of CABG and PCI after Non-ST Elevation Myocardial Infarction Among Elderly Patients from NHDS. Cureus 2020; 12:e6814. [PMID: 32140370 PMCID: PMC7047937 DOI: 10.7759/cureus.6814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Management of elderly patients with Non-ST Elevation Myocardial Infarction (NSTEMI) continues to be a source of controversy due to underrepresentation in large-scale clinical trials and the increased risk of adverse outcomes after both invasive (Percutaneous coronary intervention and Coronary artery bypass grafting) and non-invasive therapies. Recent randomized clinical trials have shown improved short term and intermediate term outcomes among high risk NSTEMI patients receiving early invasive management versus conservative medical management. However, how this is reflected in U.S. clinical practice for elderly patients has not been reported. Objective To identify the trend of invasive management in patients with NSTEMI, particularly among elderly population. Methods We used data from National Hospital Discharge Survey to identify all adult patients with an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code for NSTEMI from the years 2005 to 2009. The goal was to investigate the trends in time of invasive therapy for patients diagnosed with NSTEMI. We then stratified the patients according to age >65 and ≤65, and compared the temporal trends between two age groups. Results Among 21,306 patients diagnosed with NSTEMI between 2005 and 2009, the median age was 73 years (IQR: 61-82 years), 54% were males and 57% were White. The proportions of patients age>65 years receiving invasive management (21%, N=13978) was significantly lower than those age≤65 (41%, N=7328) (p<0.001). Moreover, in both age groups, the proportion of patients receiving early invasive management decreased substantially over time (p<0.001). Conclusion Despite numerous studies promoting the use of early invasive management for NSTEMI patients, the proportion of patients receiving invasive intervention gradually decreased from 2005-2009, more so in elderly population. The decrease seen in overall proportion of patients receiving invasive therapy could be associated with older median age of NSTEMI patients; 73 years (IQR: 61-82). Our future analyses will investigate if this trend maintains after adjusting for other factors (sex, co-morbid conditions, insurance status, year of procedure, hospital region, and hospital bed-size) thought to be associated with the management of NSTEMI in elderly patients.
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Affiliation(s)
- Muhammad U Siddiqui
- Hospital Medicine/Internal Medicine, Marshfield Clinic Medical Center, Rice Lake, USA
| | - Codruta Chiuzan
- Biostatistician, Mailman School of Public Health, New York City, USA
| | | | | | - Zunaira Naeem
- Pathology, Thomas Jefferson University, Philadelphia, USA
| | - Shariful Islam
- Epidemiology and Public Health, Deakin University, Victoria, AUS
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Contemporary invasive management and in-hospital outcomes of patients with non-ST-segment elevation myocardial infarction in China: Findings from China Acute Myocardial Infarction (CAMI) Registry. Am Heart J 2019; 215:1-11. [PMID: 31255895 DOI: 10.1016/j.ahj.2019.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 05/26/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Few studies have investigated the use of invasive strategy for patients with non-ST-segment elevation myocardial infarction (NSTEMI) in China. We aimed to describe the contemporary pattern of management, medically and invasively, in patients with NSTEMI across China. METHODS Using data of China Acute Myocardial Infarction Registry, we analyzed the baseline characteristics, in-hospital medication, index coronary angiography (CAG) and revascularization by stratification of gender, age, and risk assessment. Primary outcomes included in-hospital major adverse cardio-cerebral events (MACCE, a composite of all-cause death, myocardial (re)infarction, and stroke) and length of stay (LOS). RESULTS A total of 10,266 NSTEMI patients were enrolled between January 2013 and November 2016. Dual antiplatelet therapy and statins were prescribed in 92.9% and 92.1% of overall patients respectively. CAG was performed in 45.6% of these patients, and 40.9% had an index revascularization. Female, older or higher risk patients were less likely to receive CAG or revascularization. The rates of CAG were 67.9% in the provincial-level, 46.2% in the prefectural, and 12.1% in the county-level hospitals. Of those patients undergoing revascularization, 77.0% (1,156/1,501) very-high-risk patients received urgent revascularization and 16.2% (440/2,699) high-risk patients underwent early revascularization as recommended. The overall in-hospital MACCE was 6.7%, and the median LOS was 10 (6) days. Revascularization was associated with reduction for in-hospital MACCE regardless of risk and age. CONCLUSION Invasive management was underused and profoundly deferred among patients with NSTEMI in China. The risk-treatment paradox, procedure deferral and medical resources distribution imbalance may represent opportunities for improvement.
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Silverio A, Cavallo P, De Rosa R, Galasso G. Big Health Data and Cardiovascular Diseases: A Challenge for Research, an Opportunity for Clinical Care. Front Med (Lausanne) 2019; 6:36. [PMID: 30873409 PMCID: PMC6401640 DOI: 10.3389/fmed.2019.00036] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 02/05/2019] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular disease (CVD) accounts for the majority of death and hospitalization, health care expenditures and loss of productivity in developed country. CVD research, thus, plays a key role for improving patients' outcomes as well as for the sustainability of health systems. The increasing costs and complexity of modern medicine along with the fragmentation in healthcare organizations interfere with improving quality care and represent a missed opportunity for research. The advancement in diagnosis, therapy and prognostic evaluation of patients with CVD, indeed, is frustrated by limited data access to selected small patient populations, not standardized nor computable definition of disease and lack of approved relevant patient-centered outcomes. These critical issues results in a deep mismatch between randomized controlled trials and real-world setting, heterogeneity in treatment response and wide inter-individual variation in prognosis. Big data approach combines millions of people's electronic health records (EHR) from different resources and provides a new methodology expanding data collection in three direction: high volume, wide variety and extreme acquisition speed. Large population studies based on EHR holds much promise due to low costs, diminished study participant burden, and reduced selection bias, thus offering an alternative to traditional ascertainment through biomedical screening and tracing processes. By merging and harmonizing large data sets, the researchers aspire to build algorithms that allow targeted and personalized CVD treatments. In current paper, we provide a critical review of big health data for cardiovascular research, focusing on the opportunities of this largely free data analytics and the challenges in its realization.
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Affiliation(s)
- Angelo Silverio
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Pierpaolo Cavallo
- Department of Physics "E.R. Caianiello", University of Salerno, Salerno, Italy
| | - Roberta De Rosa
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Gennaro Galasso
- Cardiology Unit, Cardiovascular and Thoracic Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy
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Kheiri B, Osman M, Abdalla A, Haykal T, Chahine A, Gwinn M, Ahmed S, Hassan M, Bachuwa G, Bhatt DL. Drug-Eluting Versus Bare-Metal Stents in Older Patients: A Meta-Analysis of Randomized Controlled Trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:744-751. [PMID: 30446398 DOI: 10.1016/j.carrev.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/22/2018] [Accepted: 11/01/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite the high prevalence of ischemic heart disease in older patients, there is a substantial lack of evidence to guide clinical decision-making in this population. Hence, we performed a meta-analysis to determine the safety and efficacy of percutaneous coronary intervention (PCI) with drug-eluting stents (DES) versus bare-metal stents (BMS). METHODS Electronic databases were searched for randomized trials comparing DES with BMS in patients ≥70 years-old. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included different ischemic and bleeding events. Subgroup analyses for dual-antiplatelet therapy (DAPT) duration were conducted. RESULTS We included 7 trials with a total of 5449 patients. The use of DES compared with BMS was associated with a significant reduction in MACE (odds ratio [OR]:0.76; 95% confidence interval [CI]:0.62-0.93; P = 0.007) with no increased risk of bleeding events (OR: 1.07; 95% CI: 0.89-1.27; P = 0.48). However, longer duration of DAPT (>6 months) for the DES group increased bleeding events (OR: 1.52; 95% CI: 1.05-2.20; P = 0.03). In contrast, shorter DAPT showed persistent efficacy in reducing MACE in DES-treated patients with no increased bleeding events (OR: 0.72; 95% CI: 0.60-0.87; P < 0.01 and OR: 1.01; 95% CI: 0.84-1.22; P = 0.89, respectively). CONCLUSIONS In older patients who had undergone PCI, DES showed superior efficacy in reducing MACE with no increased risk of bleeding compared with BMS. Persistent MACE reduction was evident with shorter DAPT durations in DES-treated patients. SUMMARY This meta-analysis of randomized clinical trials demonstrated that drug-eluting stents were associated with a significant reduction in major adverse cardiovascular events with no increased risk of bleeding compared with bare-metal stents. The risk of bleeding was high with longer dual antiplatelet therapy duration for patients who underwent DES placement. However, short duration of dual antiplatelet therapy substantially reduced major adverse cardiovascular events with no increased bleeding risk.
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Affiliation(s)
- Babikir Kheiri
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI 48503, USA
| | - Mohammed Osman
- Division of Cardiology, West Virginia University School of Medicine, Morgantown, WV 26506, USA
| | - Ahmed Abdalla
- Division of Hematology & Oncology, St. John Hospital, Grosse Pointe Woods, MI 48236, USA
| | - Tarek Haykal
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI 48503, USA
| | - Adam Chahine
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI 48503, USA
| | - Meghan Gwinn
- Michigan State University, College of Human Medicine, Flint, MI 48502, USA
| | | | - Mustafa Hassan
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI 48503, USA
| | - Ghassan Bachuwa
- Department of Internal Medicine, Hurley Medical Center, Michigan State University, Flint, MI 48503, USA
| | - Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA 02115, USA.
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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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Breining A, Negers A, Mora L, Moïsi L, Golmard JL, Cohen A, Verny M, Collet JP, Boddaert J. Determinants of clinical presentation on outcomes in older patients with myocardial infarction. Geriatr Gerontol Int 2018; 18:1591-1596. [PMID: 30311337 DOI: 10.1111/ggi.13530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 07/25/2018] [Accepted: 08/13/2018] [Indexed: 11/30/2022]
Abstract
AIM Myocardial infarction without chest pain misleads the clinician, resulting in a diagnosis delay and an increase of mortality. The main objective of the present study was to determine the risk factors of atypical presentation in older patients with myocardial infarction. METHODS All consecutive patients aged ≥75 years presenting with myocardial infarction and hospitalized in the cardiology intensive care unit were included in the present prospective multicenter observational study. All patients benefited from both specialized cardiac management and geriatric assessment. RESULTS A total of 215 consecutive patients were included. The mean age was 85 ± 6 years. A total of 142 patients (66%) had a typical presentation (i.e. chest pain) and 73 patients (34%) had an atypical clinical presentation (i.e. no chest pain). A total of 29 (13.5%) patients died within 30 days of the index hospitalization. Higher Cumulative Illness Rating Score-Geriatric severity index score (P = 0.019) and initial atrial fibrillation (P = 0.022) were predictive of 30-day all-cause mortality. Typical presentation (P = 0.010) was a protective factor of 30-day all-cause mortality. A Cumulative Illness Rating Score for Geriatrics total score increase (P = 0.0003) and residing in a nursing home (P = 0.024) emerged as independent risk factors for atypical presentation. CONCLUSIONS In "real-life" elderly patients, comorbidities influence the prognosis of myocardial infarction, but also clinical presentation. Identification of patients at risk of atypical presentation; that is, patients with multiple comorbid conditions, might help refine the prognostic value in older patients with myocardial infarction. Geriatr Gerontol Int 2018; 18: 1591-1596.
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Affiliation(s)
- Alice Breining
- APHP, DHU FAST, Department of Geriatrics, Pitié Salpêtrière - Charles Foix University Hospital, Paris, France
| | - Antonin Negers
- APHP, Acute Geriatric Care Unit, Saint-Antoine University Hospital, Paris, France
| | - Lucie Mora
- APHP, DHU FAST, Department of Geriatrics, Pitié Salpêtrière - Charles Foix University Hospital, Paris, France
| | - Laura Moïsi
- APHP, Acute Geriatric Care Unit, Saint-Antoine University Hospital, Paris, France
| | - Jean L Golmard
- APHP, Department of Biostatistics, Pitié Salpêtrière - Charles Foix University Hospital, Paris, France
| | - Ariel Cohen
- APHP, Department of Cardiology, Saint-Antoine University Hospital, Paris, France
| | - Marc Verny
- APHP, DHU FAST, Department of Geriatrics, Pitié Salpêtrière - Charles Foix University Hospital, Paris, France.,Sorbonne Universités, UPMC University of Paris 06, Paris, France
| | - Jean P Collet
- APHP, Department of Cardiology, Pitié Salpêtrière - Charles Foix University Hospital, Paris, France
| | - Jacques Boddaert
- APHP, DHU FAST, Department of Geriatrics, Pitié Salpêtrière - Charles Foix University Hospital, Paris, France.,Sorbonne Universités, UPMC University of Paris 06, Paris, France
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11
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De Rosa R, Palmerini T, De Servi S, Belmonte M, Crimi G, Cornara S, Calabrò P, Cattaneo M, Maffeo D, Toso A, Bartorelli A, Palmieri C, De Carlo M, Capodanno D, Genereux P, Angiolillo D, Piscione F, Galasso G. High on-treatment platelet reactivity and outcome in elderly with non ST-segment elevation acute coronary syndrome - Insight from the GEPRESS study. Int J Cardiol 2018; 259:20-25. [DOI: 10.1016/j.ijcard.2018.01.057] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/09/2017] [Accepted: 01/15/2018] [Indexed: 11/16/2022]
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12
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Garg A, Garg L, Agarwal M, Rout A, Raheja H, Agrawal S, Rao SV, Cohen M. Routine Invasive Versus Selective Invasive Strategy in Elderly Patients Older Than 75 Years With Non-ST-Segment Elevation Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. Mayo Clin Proc 2018; 93:436-444. [PMID: 29439831 DOI: 10.1016/j.mayocp.2017.11.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 10/24/2017] [Accepted: 11/03/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate outcomes of routine invasive strategy (RIS) compared with selective invasive strategy (SIS) in elderly patients older than 75 years with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS We systematically searched databases for randomized controlled trials (RCTs) between January 1, 1990, and October 1, 2016, comparing RIS with SIS for elderly patients (age>75 years) with NSTE-ACS. Random effects meta-analysis was conducted to estimate odds ratio (OR) with 95% CIs for composite of death or myocardial infarction (MI), and individual end points of all-cause death, cardiovascular (CV) death, MI, revascularization, and major bleeding. RESULTS A total of 6 RCTs with 1887 patients were included in the final analysis. Compared with an SIS, RIS was associated with significantly decreased risk of the composite end point of death or MI (OR, 0.65; 95% CI, 0.51-0.83). Similarly, RIS led to a significant reduction in the risk of MI (OR, 0.51; 95% CI, 0.40-0.66) and need for revascularization (OR, 0.31; 95% CI, 0.11-0.91) compared with SIS. There were no significant differences between RIS and SIS in terms of all-cause death (OR, 0.85; 95% CI, 0.63-1.20), CV death (OR, 0.84; 95% CI, 0.61-1.15), and major bleeding (OR, 1.96; 95% CI, 0.97-3.97). CONCLUSION In elderly patients older than 75 years with NSTE-ACS, RIS is superior to SIS for the composite end point (death or MI), primarily driven by reduced risk of MI.
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Affiliation(s)
- Aakash Garg
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ.
| | - Lohit Garg
- Division of Cardiology, Lehigh Valley Hospital, Allentown, PA
| | - Manyoo Agarwal
- Department of Medicine, University of Tennessee Medical Center, Knoxville, TN
| | - Amit Rout
- Department of Medicine, Sinai Hospital, Baltimore, MD
| | - Hitesh Raheja
- Department of Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Sahil Agrawal
- Division of Cardiology, Saint Luke's University Hospital, Bethlehem, PA
| | - Sunil V Rao
- Duke Clinical Research Institute, Durham, NC
| | - Marc Cohen
- Division of Cardiology, Newark Beth Israel Medical Center, Newark, NJ
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Leng W, Yang J, Li W, Wang Y, Yang YJ. Rationale and design of the DEAR-OLD trial: Randomized evaluation of routinely Deferred versus EARly invasive strategy in elderly patients of 75 years or OLDer with non-ST-elevation myocardial infarction. Am Heart J 2018; 196:65-73. [PMID: 29421016 DOI: 10.1016/j.ahj.2017.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Comparing with conservative strategy, early invasive approach has been shown to be beneficial for initially stabilized patients with non-ST-elevation myocardial infarction (NSTEMI). However, concerns of increased risk of bleeding and other complications associated with early revascularization in patients aged ≥75 years persist. A routinely deferred invasive strategy aiming to facilitate revascularization after stabilizing the culprit lesion predominates across China. AIM The aim was to compare efficacy and safety of deferred invasive strategy versus guideline-recommended early invasive strategy in initially stabilized Chinese patients aged ≥75 years with NSTEMI. METHODS Twenty qualified centers from 10 different provinces throughout mainland China will contribute to the study. Eligible patients will be central randomized to a routine deferred invasive approach or an early invasive approach (coronary angiography >72 hours or <24 hours of admission and appropriate revascularization). Patients meeting the inclusion criteria but not randomized for any reason will be registered. The primary end point of the present study is a composite of all-cause mortality, nonlethal (re) MI, ischemic stroke, and urgent revascularization at 1 year. Noninferiority design is used, and the inferiority margin was set to be 5%. The goal is to enroll 696 patients with expected primary end point rates of 30%, 2-tailed α of .05, power of 80%, and dropout rate of 5%. CONCLUSIONS The DEAR-OLD trial is a prospective, nationwide, multicenter, noninferiority-designed, open-label randomized clinical trial evaluating efficacy and safety of routinely deferred invasive strategy compared with early invasive strategy in Chinese elderly patients with NSTEMI.
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Saraswat A, Rahman A, Singh K. An Invasive vs a Conservative Approach in Elderly Patients with Non-ST-Segment Elevation Myocardial Infarction: Systematic Review and Meta-Analysis. Can J Cardiol 2017; 34:274-280. [PMID: 29395710 DOI: 10.1016/j.cjca.2017.11.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/09/2017] [Accepted: 11/26/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Elderly (≥ 75 years) patients form a large sub-group of non-ST-segment elevation myocardial infarction (NSTEMI) population but are vastly under-represented in trials. Thus, the benefits of an early angiography in the elderly remain unclear. In this systematic review, we compared outcomes of "invasive" and "conservative" strategies of NSTEMI management in elderly patients. METHODS A comprehensive search of major databases was performed. We included comparative studies of any design that enrolled patients ≥ 75 years, and where outcomes of both strategies of NSTEMI management were available. RESULTS Among the included studies (3 randomized and 6 observational), there were 6340 patients in the "invasive" group and 13,358 patients in the "conservative" group. The 12-month mortality rate (odds ration [OR], 0.45; p < 0.00001), the 30-day mortality (OR, 0.50; p = 0.0009), and events of stroke (OR, 0.42; p < 0.00001) were significantly lower in the invasive group. Major bleeding was higher in the invasive cohort (OR, 1.63; p = 0.03). Analysis of randomised studies showed lower reinfarction with invasive approach at 12 months (p = 0.0001). Significant heterogeneity was noted among studies according to study design. CONCLUSION The overall benefit with invasive strategy comes from the data of observational studies that are prone to selection bias. We believe that there is a need for a large randomized study in the elderly patients regarding management of NSTEMI.
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Affiliation(s)
- Avadhesh Saraswat
- Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Atifur Rahman
- Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia; Department of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Kuljit Singh
- Department of Cardiology, Gold Coast University Hospital, Gold Coast, Queensland, Australia; Department of Medicine, Griffith University, Gold Coast, Queensland, Australia; Department of Medicine, University of Adelaide, Adelaide, South Australia, Australia.
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15
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Paratz ED, Nicolaides S, Layland J. Many shades of grey: seeking the optimal medical therapy of acute coronary syndrome in older people. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Jamie Layland
- Peninsula Health Heart Service; Frankston Australia
- Peninsula Clinic School; Monash University; Frankston Australia
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16
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Ma W, Liang Y, Zhu J. Early Invasive Versus Initially Conservative Strategy in Elderly Patients Older Than 75 Years with Non-ST-Elevation Acute Coronary Syndrome: A Meta-Analysis. Heart Lung Circ 2017; 27:611-620. [PMID: 28802810 DOI: 10.1016/j.hlc.2017.06.725] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Revised: 04/11/2017] [Accepted: 06/19/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fear of complications related to the procedure and unclear benefits in elderly patients are common reasons for invasive angiography being withheld. METHODS We searched PubMed and Embase from inception until February 2016 for studies that enrolled individuals older than 75 years with non-ST-elevation acute coronary syndrome (NSTE-ACS) and allocated patients to either an invasive or conservative strategy. RESULTS Thirteen studies (four randomised controlled trials (RCTs) and nine observational studies) enrolling 832,007 elderly NSTE-ACS patients were analysed. Compared with the conservative treatment, the early invasive approach does significantly reduce the risk of death at follow-up from 6 months to 5 years (risk ratio [RR] 0.65, 95% confidence interval [CI] 0.59-0.73, p<0.001); the definite benefit was mainly observed in observational studies (RR 0.63, 95% CI 0.57-0.70, p<0.001), and the risk of death also showed a strong trend toward reduction with invasive approach (RR 0.82, 95% CI 0.64-1.05, p=0.119) in RCTs. For the outcome of bleeding complications, there was a higher risk of any bleeding occurring in-hospital (RR 2.51, 95% CI 1.53-4.11, p<0.001) in patients treated with invasive strategy than those treated with conservative strategy. However, no difference of in-hospital major bleeding (RR 1.78, 95% CI 0.31-10.13, p=0.514) was observed between the two strategies. CONCLUSION Elderly patients with NSTE-ACS might benefit from an early invasive strategy but with increasing risk of any bleeding complications. More RCTs are needed to assess early invasive strategies in the elderly.
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Affiliation(s)
- Wenfang Ma
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| | - Yan Liang
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| | - Jun Zhu
- State Key Laboratory of Cardiovascular Disease, Emergency and Critical Care Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
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Blanco S, Ferrières J, Bongard V, Toulza O, Sebai F, Billet S, Biendel C, Lairez O, Lhermusier T, Boudou N, Campelo-Parada F, Roncalli J, Galinier M, Carrié D, Elbaz M, Bouisset F. Prognosis Impact of Frailty Assessed by the Edmonton Frail Scale in the Setting of Acute Coronary Syndrome in the Elderly. Can J Cardiol 2017; 33:933-939. [DOI: 10.1016/j.cjca.2017.03.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 03/26/2017] [Accepted: 03/29/2017] [Indexed: 01/04/2023] Open
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Piccolo R, Magnani G, Ariotti S, Gargiulo G, Marino M, Santucci A, Franzone A, Tebaldi M, Heg D, Windecker S, Valgimigli M. Ischaemic and bleeding outcomes in elderly patients undergoing a prolonged versus shortened duration of dual antiplatelet therapy after percutaneous coronary intervention: insights from the PRODIGY randomised trial. EUROINTERVENTION 2017; 13:78-86. [DOI: 10.4244/eij-d-16-00497] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Conti E, Musumeci MB, Desideri JP, Ventura M, Fusco D, Zezza L, De Giusti M, Berni A, Francia P, Volpe M, Autore C. Outcomes of early invasive treatment strategy in elderly patients with non-ST elevation acute coronary syndromes. J Cardiovasc Med (Hagerstown) 2016; 17:736-43. [DOI: 10.2459/jcm.0000000000000364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Sinclair H, Batty JA, Qiu W, Kunadian V. Engaging older patients in cardiovascular research: observational analysis of the ICON-1 study. Open Heart 2016; 3:e000436. [PMID: 27547431 PMCID: PMC4975868 DOI: 10.1136/openhrt-2016-000436] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 05/05/2016] [Accepted: 06/30/2016] [Indexed: 01/23/2023] Open
Abstract
Background As a consequence of population ageing, the number of older patients presenting with acute coronary syndrome (ACS) is increasing. The historical underrepresentation of older patients in many pivotal ACS clinical trials undermines the practice of evidence-based medicine in this high-risk cohort. This study evaluates the feasibility of recruitment of older patients to a longitudinal, clinical study. Methods The study to Improve Cardiovascular Outcomes in high-risk patieNts with ACS (ICON-1) is an observational, prospective cohort study investigating predictors of poor outcome in older patients with ACS. All patients aged ≥75 years, referred to a tertiary cardiovascular centre in the North East of England for coronary angiography with a view to urgent percutaneous coronary intervention, were screened for inclusion. A screening log was prospectively maintained, and a detailed analysis was performed to identify the factors associated with recruitment and non-recruitment to ICON-1. Results Of the 629 patients screened over 34 months, 457 (72.7%) satisfied the a priori-defined study inclusion/exclusion criteria. Of those eligible to participate, 300 (68.5%) provided informed consent and were recruited to the study; 59 (13.5%) were unable to consent due to a lack of capacity or limitations in communication, and 79 patients (18.0%) declined to participate in the study. Those lacking adequate capacity to consent were older than those able to provide informed consent (83.0±4.7 vs 81.0±4.7 years, p=0.002). Women were more likely to decline than men (25.1% vs 10.0%, p<0.001). Conclusions The recruitment of patients was robust, comparing favourably to previous longitudinal studies within this age group. Although enrolling older people to research remains challenging, this cohort is enthusiastic to participate. The contribution of older patients must not be ignored, particularly in the setting of an ever-ageing population, in whom cardiovascular disease burden is high. Trial registration number NCT01933581; Pre-results.
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Affiliation(s)
- Hannah Sinclair
- Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jonathan A Batty
- Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Weiliang Qiu
- Channing Division of Network Medicine , Brigham and Women's Hospital and Harvard Medical School , Boston, Massachusetts , USA
| | - Vijay Kunadian
- Faculty of Medical Sciences, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Selección de temas de actualidad en cardiología clínica, cardiología geriátrica e insuficiencia cardiaca y trasplante 2015. Rev Esp Cardiol 2016. [DOI: 10.1016/j.recesp.2015.10.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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23
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Clinical Cardiology, Geriatric Cardiology, Heart Failure, and Transplantation 2015: A Selection of Topical Issues. ACTA ACUST UNITED AC 2016; 69:159-66. [PMID: 26795924 DOI: 10.1016/j.rec.2015.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 10/21/2015] [Indexed: 01/24/2023]
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Mizuguchi Y, Hashimoto S, Yamada T, Taniguchi N, Nakajima S, Hata T, Takahashi A. Percutaneous coronary intervention for nonagenarian patients with ST-segment elevation myocardial infarction: Experience of a single Japanese center. J Cardiol 2016; 67:331-4. [PMID: 26775888 DOI: 10.1016/j.jjcc.2015.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 11/11/2015] [Accepted: 12/01/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Old age is a prognostic risk factor for patients with ST elevation acute myocardial infarction (STEMI); however, few data exist describing STEMI patients aged over 90 years. METHODS We retrospectively evaluated the clinical indices and outcomes of 282 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) in our hospital between January 2008 and December 2012. Patients with acute myocardial infarction complicated by out-of-hospital cardiopulmonary arrest, patients with a left main trunk culprit lesion, and patients diagnosed more than 24h after symptom onset were excluded. RESULTS Of the patients treated during the study period, 11 (3.8%) were >90 years old. The mean door-to-balloon time was significantly longer for nonagenarians than younger patients (66.2 vs. 44.0minutes; p<0.001). This was mainly attributed to delays in decision-making regarding invasive treatment by both the doctors and families. Nonagenarians had multiple coronary artery stenoses more frequently (36.4% vs. 15.0%; p<0.05) and required intra-aortic balloon pumping more often (36.4% vs. 18.9%; p=0.15) compared with patients aged ≤89 years. However, the peak creatinine kinase levels and the left ventricular ejection fractions were similar between the groups. Moreover, the in-hospital and 30-day mortality rates were similar (9.1% vs. 4.6%, p=0.50; 9.1% vs. 3.6%, p=0.34, respectively) between the groups. The two-year survival rate was 81.8% in nonagenarians. CONCLUSIONS Despite the longer door-to-balloon time, higher use of intra-aortic balloon pumping, and larger number of diseased vessels, the 30-day and 2-year survival rates of nonagenarians with STEMI were comparable to those of younger patients.
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Affiliation(s)
- Yukio Mizuguchi
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan.
| | - Sho Hashimoto
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan
| | - Takeshi Yamada
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan
| | | | | | - Tetsuya Hata
- Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan
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Liu Z, Zhao L, Li Y, Wang Z, Liu L, Zhang F. Evaluation of early interventional treatment opportunity of the elderly & high-risk patients with non-ST segment elevation acute myocardial infarction. Pak J Med Sci 2015; 31:1053-6. [PMID: 26648985 PMCID: PMC4641254 DOI: 10.12669/pjms.315.7881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To investigate the effect of treatment on prognosis of patients with different timing of early interventional treatment for non-ST segment elevation acute myocardial infarction (NSTEMI). Methods: Forty two cases above 75 years old, diagnosed with high-risk on NSTEMI, were selected in cardiology department of Xinxiang central hospital. They were randomly divided into two groups: 22 in group A and 20 in group B. Group A was performed PCI surgery within 12 hours after the onset while group B from 12 to 24 hour after the onset. Major adverse cardiovascular events (including death, heart failure readmission rates after ischemia, malignant arrhythmias, again target vessel revascularization) and bleeding data were recorded at the three terms of hospitalization, one month after the onset and six months after the onset. Results: Angina, malignant arrhythmia and heart failure during hospitalization can be reduced after interventional treatment carried out within 12 hours after the onset. Readmission rates after ischemia, heart failure and the incidence of death can be significantly reduced after interventional treatment carried out during 1-6 month after the onset with no significant increase in bleeding rate. Conclusion: In the treatment of elderly patients with NSTEMI, early interventional treatment is safe and effective.
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Affiliation(s)
- Zhiqiang Liu
- Zhiqiang Liu, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Lipei Zhao
- Lipei Zhao, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Yibo Li
- Yibo Li, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Zhifang Wang
- Zhifang Wang, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Lingling Liu
- Lingling Liu, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
| | - Fucheng Zhang
- Fucheng Zhang, Department of Cardiology, Xinxiang Central Hospital, Xinxiang 453000, China
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Marçula M, Aiello VD. Case 5/2015 - 88-Year-Old Female with Chronic Coronary Artery Disease, Upper Limb Thrombosis, Atrial Fibrillation and Cardiac Arrest. Arq Bras Cardiol 2015; 105:527-35. [PMID: 26577720 PMCID: PMC4651412 DOI: 10.5935/abc.20150143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Magaly Marçula
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de
Medicina da Universidade de São Paulo, São Paulo, SP – Brazil
| | - Vera Demarchi Aiello
- Instituto do Coração (InCor) do Hospital das Clínicas da Faculdade de
Medicina da Universidade de São Paulo, São Paulo, SP – Brazil
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