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Instenes I, Fridlund B, Borregaard B, Larsen AI, Allore H, Bendz B, Deaton C, Rotevatn S, Fålun N, Norekvål TM. 'When age is not a barrier': an explorative study of nonagenarian patients' experiences of undergoing percutaneous coronary intervention. Eur J Cardiovasc Nurs 2024; 23:608-617. [PMID: 38243638 DOI: 10.1093/eurjcn/zvad132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/29/2023] [Accepted: 12/09/2023] [Indexed: 01/21/2024]
Abstract
AIMS The recent rise in the number of nonagenarians (age ≥ 90 years) undergoing percutaneous coronary intervention (PCI) has revealed gaps in research, in particular on patients' experiences. Therefore, the aim of the study was to explore and describe nonagenarians' internal resources and their experiences of the in-hospital pathway. METHODS AND RESULTS Nineteen nonagenarian patients (women n = 9), mean age 91 years, 9 acutely, and 10 electively treated, were consecutively enrolled from a tertiary university hospital from June 2021 to February 2023. In-depth interviews were conducted during hospitalization, audiotaped and transcribed. The interviews were analysed using qualitative content analysis. Three sub-themes emerged from the nonagenarians' experiences with the PCI treatment trajectory: (i) Taking lifelong responsibility for own physical and mental health describes a population striving to live a healthy life and to stay independent. Physical and mental activities including healthy food choices had been an integral aspect of their lives from early childhood. (ii) Individual internal resources influenced the PCI pathway describes how their internal resources were used, from actively engaging in the decision-making process to withstanding discomfort during the PCI procedure. (iii) The post-PCI pathway was multifaceted describes a short stay at the cardiac ward with individual post-procedural experiences, close monitoring, and preparation for discharge including cardiac rehabilitation. CONCLUSION Nonagenarians undergoing PCI demonstrated a personal incentive to stay healthy and independent. Their internal resources of independence, stoicism, and resilience were used during their in-hospital stay contributing to a successful PCI procedure. Individual cardiac rehabilitation strategies were highlighted after discharge from hospital.
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Affiliation(s)
- Irene Instenes
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies vei 87, 5020 Bergen, Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Universitetsplatsen 1, 352 52 Växjö, Sweden
| | - Britt Borregaard
- Department of Cardiology, Odense University Hospital, J.B. Winsløws Vej 4, 5000 Odense C, Denmark
- Department of Clinical Research, Faculty of Health Science, University of Southern Denmark, Campus vej 55, 5230 Odense C, Denmark
| | - Alf Inge Larsen
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies vei 87, 5020 Bergen, Norway
- Department of Cardiology, Stavanger University Hospital, Gerd-Ragna Bloch Thorsens gate, 4011 Stavanger, Norway
| | - Heather Allore
- Department of Internal Medicine, Yale School of Medicine, Yale University, 300 George St 7th FL, New Haven, CT 06437, USA
- Department of Biostatistics, Yale School of Public Health, Yale University, 300 George St 7th FL, New Haven, CT 06437, USA
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Sognsvannsveien 20, 0372 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Søsterhjemmet, Kirkeveien 166, 0450 Oslo, Norway
| | - Christi Deaton
- Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge, UK
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Nina Fålun
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Laboratory Building, Haukeland University Hospital, Jonas Lies vei 87, 5020 Bergen, Norway
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Tokuda K, Tanaka A, Uemura Y, Shibata N, Iwama M, Sakaguchi T, Yoshida R, Negishi Y, Tashiro H, Tanaka M, Tatami Y, Yamaguchi S, Yoshioka N, Umemoto N, Ohashi T, Takada Y, Asano H, Yoshida Y, Tanaka T, Noda T, Morishima I, Ishii H, Murohara T. Long-term clinical outcomes following percutaneous coronary intervention in patients aged 90 years and older. J Cardiol 2024:S0914-5087(24)00132-1. [PMID: 39034030 DOI: 10.1016/j.jjcc.2024.07.004] [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: 03/05/2024] [Revised: 06/18/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND In an aging society, percutaneous coronary intervention (PCI) for super-elderly patients is commonly performed in clinical practice. However, data are scarce regarding the clinical features and outcomes of this population. METHODS This multicenter observational study enrolled patients aged over 90 years who underwent PCI across 10 hospitals between 2011 and 2020. The study included patients presenting with acute coronary syndrome (ACS) and chronic coronary syndrome (CCS). The occurrence of all-cause and cardiac deaths during hospitalization and after discharge was investigated. RESULTS In total, 402 patients (91.9 ± 2.0 years, 48.3 % male) participated in the study, of whom 77.9 % presented with ACS. The rate of in-hospital death was significantly higher in patients with ACS compared to patients with CCS (15.3 % vs. 2.2 %, p < 0.001). The estimated cumulative incidence rates of all-cause death were 24.3 %, 39.5 %, and 60.4 % at 1, 3, and 5 years, respectively. No significant difference was observed in the occurrence of all-cause death between patients with ACS and CCS. Regarding causes of death after discharge, non-cardiac deaths accounted for just over half of the cases. CONCLUSION This study highlights the clinical features and long-term clinical course of patients aged over 90 years who underwent PCI in a real-world setting. Patients presenting with ACS exhibited a higher rate of in-hospital mortality compared to those with CCS. Following discharge, both ACS and CCS patients experienced comparable and substantial increases in the incidence rates of both cardiac and non-cardiac mortality over time, and a more holistic management approach is warranted.
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Affiliation(s)
- Kotaro Tokuda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Naoki Shibata
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Makoto Iwama
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | | | - Ruka Yoshida
- Department of Cardiology, Japanese Red Cross Society Nagoya Daini Hospital, Nagoya, Japan
| | - Yosuke Negishi
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Hiroshi Tashiro
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Miho Tanaka
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Yosuke Tatami
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | | | - Naoki Yoshioka
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Taiki Ohashi
- Department of Cardiology, Toyota Kosei Hospital, Toyota, Japan
| | - Yasunobu Takada
- Department of Cardiology, Konan Kosei Hospital, Konan, Japan
| | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Yukihiko Yoshida
- Department of Cardiology, Japanese Red Cross Society Nagoya Daini Hospital, Nagoya, Japan
| | - Toshikazu Tanaka
- Department of Cardiology, Okazaki Municipal Hospital, Okazaki, Japan
| | - Toshiyuki Noda
- Department of Cardiology, Gifu Prefectural General Medical Center, Gifu, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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3
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Rahat O, Kheifets M, Bental T, Abigail Vons S, Tishler O, Lerman TT, Kaufman C, Perl L, Greenberg G, Codner P, Witberg G, Vaknin-Assa H, Kornowski R, Levi A. Is 90 the new 80? Temporal trends in nonagenarians undergoing percutaneous coronary interventions. Am J Med Sci 2024:S0002-9629(24)01330-2. [PMID: 38964467 DOI: 10.1016/j.amjms.2024.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Coronary artery disease (CAD) is a leading cause of death in the elderly population. Data regarding percutaneous coronary interventions (PCIs) in nonagenarians are scarce, and differences in long term outcomes between generations remain unclear. We aimed to study the pattern and temporal trends of nonagenarians treated with PCI. MATERIALS AND METHODS A total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year. MATERIALS AND METHODS A total of 14,695 patients underwent PCI between 2009-2020. We identified 2,034 (13.8%) octogenarians (age 80-89), and 222 (1.5%) nonagenarians (age 90-99). Endpoints included mortality and major adverse cardiac events (MACE) at 1 year. RESULTS The number of nonagenarians undergoing PCI has increased substantially during the study time period, from 89 patients in the earlier time period (2009-2014) to 133 patients in the later time period (2015-2020). At 1-year, nonagenarians had significantly higher rates of both death (24.3% vs. 14.9%, p<0.01), and MACE (30.6% vs. 22.0%, p<0.01), as compared to octogenarians. The cumulative survival rate was higher among octogenarians both in the early and late time period (p<0.01 and p=0.039, respectively). A significant reduction in nonagenarian MACE rates were observed during the study time period, resulting in a non-significant difference in MACE rates in the later time period between both groups. CONCLUSION The number of nonagenarians who undergo PCI is on the rise. While their clinical outcomes are inferior as compared to younger age groups, improvement was noted in the late time period.
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Affiliation(s)
- Ori Rahat
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Mark Kheifets
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tamir Bental
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly Abigail Vons
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Tishler
- Internal Department F, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tsahi T Lerman
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Internal Department F, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Leor Perl
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gabriel Greenberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Pablo Codner
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Witberg
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center, Petach Tikva; affiliated to the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Sarma D, Padkins M, Smith R, Bennett CE, Murphy JG, Bell MR, Damluji AA, Anavekar NS, Barsness GW, Jentzer JC. Patients Aged 90 Years and Above With Acute Coronary Syndrome in the Cardiac Intensive Care Unit: Management and Outcomes. Am J Cardiol 2024; 215:19-27. [PMID: 38266797 PMCID: PMC11025344 DOI: 10.1016/j.amjcard.2023.12.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/03/2023] [Accepted: 12/24/2023] [Indexed: 01/26/2024]
Abstract
Limited data exist regarding outcomes after coronary angiography (CAG) and percutaneous coronary intervention (PCI) in patients aged ≥90 years admitted to the cardiac intensive care unit (CICU) with acute coronary syndrome (ACS). We studied sequential CICU patients ≥90 years admitted with ACS from 2007 to 2018. Three therapeutic approaches were defined: (1) No CAG; (2) CAG without PCI (CAG/No PCI); and (3) CAG with PCI (CAG/PCI). In-hospital mortality was evaluated using multivariable logistic regression. All-cause 1-year mortality was evaluated using Kaplan-Meier and multivariable Cox proportional hazards analysis. The study included 239 patients with a median age of 92 (range 90 to 100) years (57% females; 45% ST-elevation myocardial infarction; 8% cardiac arrest; 16% shock). The No CAG group had higher Day 1 Sequential Organ Failure Assessment scores, more co-morbidities, worse kidney function, and fewer ST-elevation myocardial infarctions. In-hospital mortality was 20.8% overall and did not differ between the No CAG (n = 103; 21.4%), CAG/No PCI (n = 47; 21.3%), and CAG/PCI (n = 90; 20.0%) groups, before or after adjustment. Overall 1-year mortality was 52.5% and did not differ between groups before or after adjustment. Median survival was 6.9 months overall and 41.2% of hospital survivors died within 1 year of CICU admission. CICU patients aged ≥90 years with ACS have a substantial burden of illness with high in-hospital and 1-year mortality that was not lower in those who underwent CAG or PCI. These results suggest that careful patient selection for invasive coronary procedures is essential in this vulnerable population.
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Affiliation(s)
- Dhruv Sarma
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mitchell Padkins
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Ryan Smith
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Courtney E Bennett
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Joseph G Murphy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Malcolm R Bell
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Abdulla A Damluji
- Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, Virginia
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Gregory W Barsness
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jacob C Jentzer
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota; Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota.
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5
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Al-Alawy K, Sayegh KA, Moonesar IA. Optimizing interventional cardiology services. Future Cardiol 2023; 19:695-705. [PMID: 37916604 DOI: 10.2217/fca-2023-0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/11/2023] [Indexed: 11/03/2023] Open
Abstract
Cardiovascular disease (CVD) is a common and prominent cause of morbidity and mortality interventional cardiology (IC) remains an important noninvasive intervention to improve patient outcomes and life expectancy. Aim: The study objectives were to explore how IC services could be optimized. Methods: We adopted multiple methods, including policy analysis, literature review and interviews. Results: The most prominent themes were medical devices and service integration and management. IC Consultant interviews suggest the need to balance supply and demand, implement standards of practice and establish centres of excellence. Conclusion: Optimizing IC services requires a comprehensive approach, including regulatory and financial oversight, organizational management, adoption of clinical and technological best practices, ongoing training, multidisciplinary working and service integration.
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6
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Ismayl M, Machanahalli Balakrishna A, Walters RW, Pajjuru VS, Goldsweig AM, Aboeata A. In-hospital mortality and readmission after ST-elevation myocardial infarction in nonagenarians: A nationwide analysis from the United States. Catheter Cardiovasc Interv 2022; 100:5-16. [PMID: 35568973 DOI: 10.1002/ccd.30227] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/14/2022] [Accepted: 05/03/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess readmission rates in nonagenarians (age ≥ 90 years) with ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) versus no pPCI. BACKGROUND There are limited data exploring readmissions following STEMI in nonagenarians undergoing pPCI versus no pPCI. METHODS We retrospectively analyzed the Nationwide Readmissions Database to identify nonagenarians hospitalized with STEMI. We divided the cohort into two groups based on pPCI status. We compared mortality during index hospitalization and during 30-day readmission, readmission rates, and causes of readmissions. RESULTS We identified 58,231 nonagenarian STEMI hospitalizations between 2010 and 2018, of which 18,809 (32.3%) included pPCI, and 39,422 (67.7%) had no pPCI. Unadjusted unplanned 30-day readmission was higher in pPCI cohort (21.0% vs. 15.4%, p < 0.001). However, mortality during index hospitalization and during 30-day readmission were significantly lower in pPCI cohort (15.8% vs. 32.2%, p < 0.001; 7.4% vs. 14.2%, p < 0.001, respectively). After adjusting for baseline characteristics, hospitalizations that included pPCI had 25% greater odds of unplanned 30-day readmission (adjusted odds ratio [aOR]: 1.25, 95% confidence interval [CI]: 1.12-1.39, p < 0.001) and 49% lower odds of in-hospital mortality during index hospitalization (aOR: 0.51, 95% CI: 0.46-0.56, p < 0.001). Heart failure was the most common cause of readmission in both cohorts followed by myocardial infarction. CONCLUSIONS In nonagenarians with STEMI, pPCI is associated with slightly higher 30-day readmission but significantly lower mortality during index hospitalization and during 30-day readmission than no pPCI. Given the overwhelming mortality benefit with pPCI, further research is necessary to optimize the utilization of pPCI while reducing readmissions following STEMI in nonagenarians.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | | | - Ryan W Walters
- Division of Clinical Research and Evaluative Sciences, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Venkata S Pajjuru
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Andrew M Goldsweig
- Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ahmed Aboeata
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
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Jain V, Minhas AMK, Khan SU, Greene SJ, Pandey A, Van Spall HGC, Fonarow GC, Mentz RJ, Butler J, Khan MS. Trends in HF Hospitalizations Among Young Adults in the United States From 2004 to 2018. JACC. HEART FAILURE 2022; 10:350-362. [PMID: 35483798 DOI: 10.1016/j.jchf.2022.01.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 01/21/2022] [Accepted: 01/24/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The aim of this study was to assess trends in heart failure (HF) hospitalizations among young adults. BACKGROUND Data are limited regarding clinical characteristics and outcomes of young adults hospitalized for HF. METHODS The National Inpatient Sample database was analyzed to identify adults aged 18 to 45 years who were hospitalized for HF between 2004 and 2018. RESULTS In total, 767,180 weighted hospitalizations for HF in young adults were identified, equivalent to 4.32 (95% CI: 4.31-4.33) per 10,000 person-years. Overall HF hospitalizations per 10,000 U.S. population of young adults decreased from 2.43 in 2004 to 1.82 in 2012, followed by an increase to 2.51 in 2018. Black adults (50.1%) had a significantly higher proportion of HF hospitalizations compared with White (31.9%) and Hispanic adults (12.2%) throughout the study period. Nearly half of patients (45.8%) lived in zip codes in the lowest quartile of national household income. Overall, in-hospital mortality was 1.3%, which decreased over time; this trend was consistent by sex and race. The overall mean LOS (5.2 days) remained stable over time, while the mean inflation-adjusted cost increased from $12,449 in 2004 to $16,786 in 2018, with significant overall differences by race and sex. CONCLUSIONS This longitudinal examination of U.S. clinical practice revealed that HF hospitalizations among young adults have increased since 2013. Approximately half of these patients are Black and reside in zip codes in the lowest quartile of national household income. Temporal trends showed decreased in-hospital mortality, stable adjusted lengths of stay, and increased inflation-adjusted costs, with significant racial differences in hospitalization rates.
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Affiliation(s)
- Vardhman Jain
- Department of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Safi U Khan
- Houston Methodist Hospital, Houston, Texas, USA
| | - Stephen J Greene
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Harriette G C Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Population Health Research Institute, Hamilton, Ontario, Canada
| | - Gregg C Fonarow
- Division of Cardiology, David Geffen School of Medicine, University of California-Los Angeles, Medical Center, Los Angeles, California, USA
| | - Robert J Mentz
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Muhammad Shahzeb Khan
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina, USA.
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Tashiro H, Tanaka A, Takagi K, Uemura Y, Inoue Y, Umemoto N, Negishi Y, Shibata N, Yoshioka N, Shimizu K, Morishima I, Watarai M, Asano H, Ishii H, Murohara T. Incidence and Predictors of Frailty Progression among Octogenarians with ST-elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Arch Gerontol Geriatr 2022; 102:104737. [PMID: 35671551 DOI: 10.1016/j.archger.2022.104737] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/15/2022] [Accepted: 05/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Frailty is one of the most serious health problems in older individuals with cardiovascular disease. Moreover, frailty progression is associated with subsequent adverse outcomes; therefore, the prevention of frailty progression is an important clinical issue. However, the incidence and predictors of frailty progression following acute myocardial infarction have not yet been fully elucidated. METHODS The present study is a sub-analysis of an observational multicenter registry retrospectively evaluating clinical outcomes of 288 octogenarians who underwent primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) between January 2014 and December 2016 at five hospitals. We identified 244 patients who survived until discharge and evaluated frailty at baseline and discharge using the Clinical Frailty Scale (CFS). We defined frailty progression as an increase of at least one level in the CFS score at discharge from baseline and assessed the predictors of frailty progression. RESULTS Frailty progression was observed in 29.5% of patients. Patients with frailty progression were older, had more severe conditions with a higher prevalence of Killip 4 status and mechanical circulatory support use, more frequently experienced in-hospital events such as stroke (4/72, 6% vs. 0/172, 0%, p = 0.007), and had longer hospital stays than those without frailty progression [19 (11-35) vs. 13 (9-19) days, p<0.01]. Multivariate analysis showed that age (odds ratio 1.08, 95% confidence interval 1.00-1.17, p = 0.046) and Killip 4 status at baseline (odds ratio 3.34, 95% confidence interval 1.26-8.85, p = 0.01) were significant predictors of frailty progression. CONCLUSIONS In-hospital frailty progression was commonly observed in octogenarians with STEMI who underwent primary PCI and survived until discharge, and was associated with more severe clinical conditions.
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Affiliation(s)
- Hiroshi Tashiro
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Kensuke Takagi
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Yusuke Uemura
- Cardiovascular Center, Anjo Kosei Hospital, Anjo, Japan
| | - Yosuke Inoue
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Norio Umemoto
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Shibata
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan; Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | - Kiyokazu Shimizu
- Department of Cardiology, Ichinomiya Municipal Hospital, Ichinomiya, Japan
| | - Itsuro Morishima
- Department of Cardiology, Ogaki Municipal Hospital, Ogaki, Japan
| | | | - Hiroshi Asano
- Department of Cardiology, Tosei General Hospital, Seto, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Cardiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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9
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One-year outcome after percutaneous coronary intervention in nonagenarians: Insights from the J-PCI OUTCOME registry. Am Heart J 2022; 246:105-116. [PMID: 35016854 DOI: 10.1016/j.ahj.2022.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/24/2021] [Accepted: 01/06/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Nonagenarian patients who undergo percutaneous coronary intervention (PCI) are increasing, and a few previous studies have reported their long-term outcomes. However, differences in their long-term outcomes between generations remain unclear. This study aimed to investigate 1-year all-cause and cardiovascular (CV) mortality, and major adverse cardiovascular events (MACE; cardiovascular death, myocardial infarction, and stroke) of nonagenarian patients who underwent PCI compared with the other elder patients, using a nationwide registration system. METHODS The patient-level data registered between January 2017 and December 2017 was extracted from the J-PCI OUTCOME Registry endorsed by the Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT). The one-year all-cause and cardiovascular (CV) mortality, MACE, and major bleeding events were identified. RESULTS Out of 40,722 patients over 60 years of age, 880 (2.1%) were nonagenarians. For nonagenarians, the 1-year mortality rate was substantial (13.5%). The MACE and CV death rates were also high (8.1%, and 6.8%, respectively) for nonagenarians, and these event rates were approximately 1.5 times higher in nonagenarians than octogenarians. Multivariate regression analysis showed that presentation with cardiogenic shock [hazard ratio (HR) 2.32; 95 confidence intervals (CI): 1.22-4.41], or cardiac arrest (HR 2.91; 90% CI: 1.28-6.62), and use of oral anticoagulants (HR 2.10; 90% CI: 1.07-4.12) were the predictors of 1-year MACE. CONCLUSIONS Even in the contemporary era, nonagenarians who have undergone PCI still face a considerably increased risk for adverse cardiovascular events that reduces long-term survival. In addition to having poorer lesion characteristics, adverse events, including death, MACEs, and major bleeding, occurred 1.5 times more frequently in nonagenarians than in octogenarians.
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Dawson LP, Dinh D, Duffy SJ, Clark D, Reid CM, Brennan A, Andrianopoulos N, Hiew C, Freeman M, Oqueli E, Chan W, Ajani AE. Temporal Trends in Patient Risk Profile and Clinical Outcomes Following Percutaneous Coronary Intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 31:10-16. [DOI: 10.1016/j.carrev.2020.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/15/2020] [Accepted: 12/15/2020] [Indexed: 11/26/2022]
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11
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Dani SS, Minhas AMK, Arshad A, Krupica T, Goel SS, Virani SS, Sharma G, Blankstein R, Blaha MJ, Al-Kindi SG, Nasir K, Khan SU. Trends in Characteristics and Outcomes of Hospitalized Young Patients Undergoing Coronary Artery Bypass Grafting in the United States, 2004 to 2018. J Am Heart Assoc 2021; 10:e021361. [PMID: 34459230 PMCID: PMC8649273 DOI: 10.1161/jaha.121.021361] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Data are limited about young adults' characteristics and outcomes undergoing coronary artery bypass grafting (CABG). Methods and Results We used the National Inpatient Sample database to identify adults aged 18 to 45 years who underwent CABG between 2004 and 2018. The data were weighted to generate national estimates of the entire US hospitalized population. We identified 110 463 CABG cases, equivalent to 62.2 per 1 000 000 person‐years; 27.1% were women, and 70.2% were White adults. Overall, annual CABG volume per 1 000 000 significantly decreased from 87.3 in 2004 to 45.7 in 2018. The prevalence of obesity, diabetes mellitus, hypertension, drug abuse, and chronic medical conditions increased over time. Overall, inpatient mortality was 1.76%; ST‐segment–elevation myocardial infarction, non–ST‐segment–elevation myocardial infarction, heart failure, peripheral vascular disease, renal failure, and valvular surgery were associated with higher inpatient mortality. Women had higher inpatient mortality than men (2.29% versus 1.57%), and Black patients had higher deaths than White patients (2.86% versus 1.58%). Inpatient mortality remained stable overall, according to sex, race, or clinical indication of CABG. However, the mean length of stay (8.4 days in 2004 to 9.5 days in 2018) and inflation‐adjusted cost of care ($40 522.8 in 2004 to $52 434.2 in 2018) significantly increased during the study period. Conclusions Despite the increased burden of cardiometabolic risk factors, the inpatient mortality in young adults undergoing CABG remained stable during the last 15 years. However, CABG volumes have decreased, but length of stay and inflation‐adjusted costs have increased over time.
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Affiliation(s)
- Sourbha S Dani
- Division of Cardiology Lahey Hospital and Medical CenterBeth Israel Lahey Health Burlington MA
| | | | - Adeel Arshad
- Department of Medical Oncology Ohio State University Comprehensive Cancer Care Center Columbus OH
| | - Troy Krupica
- Department of Medicine West Virginia University Morgantown WV
| | - Sachin S Goel
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX
| | - Salim S Virani
- Michael E. DeBakey Veterans Affair Medical Center & Section of Cardiovascular Research Department of Medicine Baylor College of Medicine Houston TX
| | - Garima Sharma
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | - Ron Blankstein
- Cardiovascular Division Brigham and Women's Hospital Boston MA
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Cardiovascular Disease Johns Hopkins University Baltimore MD
| | - Sadeer G Al-Kindi
- Harrington Heart and Vascular InstituteUniversity Hospitals and Case Western Reserve University Cleveland OH
| | - Khurram Nasir
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX.,Center for Outcomes Research Houston Methodist Houston TX
| | - Safi U Khan
- Department of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX
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Cepas-Guillén PL, Echarte-Morales J, Caldentey G, Gómez EM, Flores-Umanzor E, Borrego-Rodriguez J, Llagostera M, Viana Tejedor A, Vidal P, Benito-Gonzalez T, Quiroga X, Ortiz AF, Freixa X, Pérez de Prado A, Sanz FN, Fernández-Vázquez F, Sabate M. Outcomes of Nonagenarians With Acute Coronary Syndrome. J Am Med Dir Assoc 2021; 23:81-86.e4. [PMID: 34197794 DOI: 10.1016/j.jamda.2021.04.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 03/23/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Nonagenarians are a fast-growing age group among cardiovascular patients, but data about their management and prognosis after an acute coronary syndrome (ACS) is scarce. This study aimed to analyze characteristics of nonagenarian patients with ACS and to compare in-hospital and 1-year clinical outcomes between those treated with medical treatment (MT) alone and those receiving percutaneous coronary intervention (PCI). DESIGN Multicenter observational study. SETTING AND PARTICIPANTS We included consecutive nonagenarian patients with ACS admitted at 4 academic centers between 2005 and 2018. Only patients with type 1 myocardial infarction were included. METHODS Standardized definitions of all patient-related variables, clinical diagnoses, and hospital complications and outcomes were used. The primary endpoint was 1-year all-cause mortality. Long-term survival was compared between patients undergoing PCI and those managed with MT alone. Given differences in baseline characteristics could substantially interfere in outcomes, 3 sensitivity analyses were performed to adjust for confounders. RESULTS A total of 680 nonagenarians were included (59% females). Of them, 373 (55%) patients presented with non-ST-segment elevation ACS (NSTE-ACS) and 307 (45%) with ST-segment elevation myocardial infarction (STEMI). A coronary angiogram was performed in 115 (31%) of NSTE-ACS and in 182 (60%) of STEMI patients with subsequent PCI in 81 (22%) and 156 (51%), respectively. Overall mortality rates were 17% in-hospital and 39% at 1-year follow-up. PCI was independently associated with a decreased risk of 1-year all-cause death [hazard ratio (HR) 0.57, 95% confidence interval (CI) 0.35, 0.95; P < .05], mainly observed in those patients without disability (HR 0.59, 95% CI 0.37, 0.94; P < .01) and lower Killip class (HR 0.50, 95% CI 0.28, 0.89; P < .001). CONCLUSIONS AND IMPLICATIONS The prognosis of nonagenarians after an ACS was associated with comorbidities and the therapeutic approach. Although PCI appeared to be a safe and effective strategy, it is still necessary to refine the decision-making process in this high-risk population group.
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Affiliation(s)
- Pedro Luis Cepas-Guillén
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | | | - Eduardo Flores-Umanzor
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | - Ana Viana Tejedor
- Cardiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Pablo Vidal
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Xavier Quiroga
- Cardiology Department, Hospital del Mar, Barcelona, Spain
| | | | - Xavier Freixa
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | | | | | - Manel Sabate
- Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain.
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Papapostolou S, Dinh DT, Noaman S, Biswas S, Duffy SJ, Stub D, Shaw JA, Walton A, Sharma A, Brennan A, Clark D, Freeman M, Yip T, Ajani A, Reid CM, Oqueli E, Chan W. Effect of Age on Clinical Outcomes in Elderly Patients (>80 Years) Undergoing Percutaneous Coronary Intervention: Insights From a Multi-Centre Australian PCI Registry. Heart Lung Circ 2021; 30:1002-1013. [PMID: 33478864 DOI: 10.1016/j.hlc.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To evaluate the effect of age in an all-comers population undergoing percutaneous coronary intervention (PCI). BACKGROUND Age is an important consideration in determining appropriateness for invasive cardiac assessment and perceived clinical outcomes. METHODS We analysed data from 29,012 consecutive patients undergoing PCI in the Melbourne Interventional Group (MIG) registry between 2005 and 2017. 25,730 patients <80 year old (78% male, mean age 62±10 years; non-elderly cohort) were compared to 3,282 patients ≥80 year old (61% male, mean age 84±3 years; elderly cohort). RESULTS The elderly cohort had greater prevalence of hypertension, diabetes and previous myocardial infarction (all p<0.001). Elderly patients were more likely to present with acute coronary syndromes, left ventricular ejection fraction <45% and chronic kidney disease (p<0.0001). In-hospital, 30-day and long-term all-cause mortality (over a median of 3.6 and 5.1 years for elderly and non-elderly cohorts, respectively) were higher in the elderly cohort (5.2% vs. 1.9%; 6.4% vs. 2.2%; and 43% vs. 14% respectively, all p<0.0001). In multivariate Cox regression analysis, estimated glomerular filtration rate (eGFR) <30 mL/min/1.73 m2 (HR 3.8, 95% CI: 3.4-4.3), cardiogenic shock (HR 3.0, 95% CI: 2.6-3.4), ejection fraction <30% (HR 2.5, 95% CI: 2.1-2.9); and age ≥80 years (HR 2.8, 95% CI: 2.6-3.1) were independent predictors of long-term all-cause mortality (all p<0.0001). CONCLUSION The elderly cohort is a high-risk group of patients with increasing age being associated with poorer long-term mortality. Age, thus, should be an important consideration when individualising treatment in elderly patients.
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Affiliation(s)
| | - Diem T Dinh
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | | | | | | | - Dion Stub
- Alfred Health, Melbourne, Vic, Australia
| | | | | | - Anand Sharma
- Ballarat Base Hospital, Ballarat Central, Vic, Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | | | | | | | - Andrew Ajani
- Royal Melbourne Hospital, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia
| | | | - Ernesto Oqueli
- Ballarat Base Hospital, Ballarat Central, Vic, Australia
| | - William Chan
- Alfred Health, Melbourne, Vic, Australia; The University of Melbourne, Melbourne, Vic, Australia.
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Meah MMN, Joseph T, Ding WY, Shaw M, Hasleton J, Palmer ND, Velavan P, Aggarwal SK. Primary percutaneous coronary intervention in nonagenarians: is it worthwhile? BMC Cardiovasc Disord 2021; 21:30. [PMID: 33435875 PMCID: PMC7805235 DOI: 10.1186/s12872-020-01833-2] [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] [Received: 09/29/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022] Open
Abstract
Background Previous studies have demonstrated the feasibility of primary percutaneous coronary intervention (PPCI) in carefully selected nonagenarians. Although current guidelines recommend immediate revascularization in patients with ST elevation myocardial infarction (STEMI) it remains unclear whether PPCI reduces mortality in nonagenarians. The objective of this study is to compare mortality in nonagenarians presenting via the PPCI pathway who undergo coronary intervention, versus those who are managed medically. Methods and results A total of 111 consecutive nonagenarians who presented to our tertiary center via the PPCI pathway between July 2013 and December 2018 with myocardial infarction were included. Clinical and angiographic details were collected alongside data on all-cause mortality. The final diagnosis was STEMI in 98 (88.3%) and NSTEMI in 13 (11.7%). PPCI was performed in 42 (37.8%), while 69 (62.2%) were medically managed. A significant number of the medically managed cohort had atrial fibrillation (23.2% vs 2.4% p = 0.003) and presented with a completed infarct (43.5% vs 4.8% p = 0.001). Other baseline and clinical variables were well matched in both groups. There was a trend towards increased 30-day mortality in the medically managed group (40.6% vs 23.8% p = 0.07). Kaplan Meier survival analysis demonstrated a significant difference in survival by 3 years (48.1% vs 21.7% p = 0.01). This was the case even when those with completed infarcts were excluded (44.3% vs 14.6%, p = 0.01).
Conclusion In this series of selected nonagenarians presenting with acute myocardial infarction, those undergoing PPCI appeared to have a lower mortality compared to those managed medically.
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Affiliation(s)
- Mohammed M N Meah
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Tobin Joseph
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK.
| | - Wern Yew Ding
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Matthew Shaw
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Jonathan Hasleton
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Nick D Palmer
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Periaswamy Velavan
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
| | - Suneil K Aggarwal
- Liverpool Heart and Chest Hospital, Thomas Drive, Liverpool, L14 3PE, UK
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15
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Babu Nelagondanahalli Manjunath S, Kumar Paramasivan N, George PV, George OK. Primary PCI in a nonagenarian: an uncommon predicament. BMJ Case Rep 2020; 13:13/12/e237650. [PMID: 33323422 PMCID: PMC7745334 DOI: 10.1136/bcr-2020-237650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Myocardial infarction in a nonagenarian is a morbid cardiac illness that can lead to significant mortality unless properly dealt with management aspects. Many comorbid or family-related issues might be part of holdbacks in management of such a group of patients. Hence, myocardial infarction in a nonagenarian where intervention is better treatment option forms an uncommon combination and has many preprocedural, periprocedural and postprocedural difficulties related to multiple issues. Here, we present a case of nonagenarian who presented with extensive anterior wall MI and was successfully dealt with primary percutaneous coronary intervention despite periprocedural and intraprocedural difficulties.
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16
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Pajjuru VS, Thandra A, Guddeti RR, Kothapalli SR, Walters RW, Jhand A, Aboeata A, Andukuri VG, Goldsweig AM. ST-elevation myocardial infarction in nonagenarians: A nationwide analysis of trends and outcomes in the United States. Catheter Cardiovasc Interv 2020; 98:638-646. [PMID: 33010099 DOI: 10.1002/ccd.29313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 09/03/2020] [Accepted: 09/21/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To assess ST elevation myocardial infarction (STEMI) trends and outcomes in nonagenarians undergoing primary percutaneous coronary intervention (pPCI) compared to medical management. BACKGROUND Although nonagenarians (age greater than 90 years) represent the fast-growing age decade of the US population, limited evidence is available regarding trends and outcomes of treatment strategies for STEMI in this population cohort. METHODS We performed a retrospective analysis using the National Inpatient Sample (NIS) database to identify nonagenarians presenting with STEMI and treated with either pPCI or medical management. In-hospital mortality, in-hospital complications, length of stay and in-hospital costs were analyzed. RESULTS Between 2010-2017, 41,042 STEMI hospitalizations were identified in nonagenarians, of which 11, 155 (27.2%) included pPCI whereas 29, 887 (72.8%) included medical management. STEMI hospitalizations among nonagenarians decreased over the study period. Overall unadjusted in-hospital mortality was 21.6%, and the hospitalizations that included pPCI had significantly lower mortality compared to the medical management (13.6% vs. 24.5%, p < .001). After adjusting for baseline characteristics, hospitalizations that included pPCI had 42.1% lower odds of in-hospital mortality (adjusted OR: 0.58, 95% CI: 0.50 to 0.67, p < .001). Altogether, in-hospital cardiac, bleeding and vascular complications, length of stay and in-hospital costs were higher in pPCI hospitalizations. CONCLUSION In nonagenarians, STEMI mortality is high, but pPCI is associated with superior outcomes compared to medical management alone. Therefore, pPCI can be considered an acceptable treatment strategy in this population.
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Affiliation(s)
- Venkata S Pajjuru
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Abhishek Thandra
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska
| | - Raviteja R Guddeti
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska
| | | | - Ryan W Walters
- Department of Medicine, Division of Clinical Research and Evaluative Sciences, Creighton University School of Medicine, Omaha, Nebraska
| | - Aravdeep Jhand
- Department of Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
| | - Ahmed Aboeata
- Department of Medicine, Division of Cardiology, Creighton University School of Medicine, Omaha, Nebraska
| | - Venkata G Andukuri
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska
| | - Andrew M Goldsweig
- Department of Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, Nebraska
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Pannell L, Ramcharitar S. Optimizing PCI Outcomes by Determining Frailty Risk. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:819-820. [PMID: 32571760 DOI: 10.1016/j.carrev.2020.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 04/28/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Laura Pannell
- Wiltshire Cardiac Centre, Marlborough Road, Swindon, SN36BB, United Kingdom.
| | - Steve Ramcharitar
- Wiltshire Cardiac Centre, Marlborough Road, Swindon, SN36BB, United Kingdom.
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Giblett JP. Does Impella Support Really Prevent Catastrophe? JACC Case Rep 2020; 2:668-669. [PMID: 34317318 PMCID: PMC8298659 DOI: 10.1016/j.jaccas.2020.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joel P. Giblett
- Division of Cardiology, Royal Jubilee Hospital, Victoria, British Columbia, Canada
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Alkhouli M, Alqahtani F, Kalra A, Gafoor S, Alhajji M, Alreshidan M, Holmes DR, Lerman A. Trends in Characteristics and Outcomes of Patients Undergoing Coronary Revascularization in the United States, 2003-2016. JAMA Netw Open 2020; 3:e1921326. [PMID: 32058558 DOI: 10.1001/jamanetworkopen.2019.21326] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
IMPORTANCE Data on the contemporary changes in risk profile and outcomes of patients undergoing percutaneous coronary intervention (PCI) or coronary bypass grafting (CABG) are limited. OBJECTIVE To assess the contemporary trends in the characteristics and outcomes of patients undergoing PCI or CABG in the United States. DESIGN, SETTING, AND PARTICIPANTS This retrospective cohort study used a national inpatient claims-based database to identify patients undergoing PCI or CABG from January 1, 2003, to December 31, 2016. Data analysis was performed from July 15 to October 4, 2019. MAIN OUTCOMES AND MEASURES Demographic characteristics, prevalence of risk factors, and clinical presentation divided into 3 eras (2003-2007, 2008-2012, and 2013-2016) and in-hospital mortality of PCI and CABG stratified by clinical indication. RESULTS A total of 12 062 081 revascularization hospitalizations were identified: 8 687 338 PCIs (72.0%; mean [SD] patient age, 66.0 [10.8] years; 66.2% male) and 3 374 743 CABGs (28.0%; mean [SD] patient age, 64.5 [12.4] years; 72.1% male). The annual PCI volume decreased from 366 to 180 per 100 000 US adults and the annual CABG volume from 159 to 82 per 100 000 US adults. A temporal increase in the proportions of older, male, nonwhite, and lower-income patients and in the prevalence of atherosclerotic and nonatherosclerotic risk factors was found in both groups. The percentage of revascularization for myocardial infarction (MI) increased in the PCI group (22.8% to 53.1%) and in the CABG group (19.5% to 28.2%). Risk-adjusted mortality increased slightly after PCI for ST-segment elevation MI (4.9% to 5.3%; P < .001 for trend) and unstable angina or stable ischemic heart disease (0.8% to 1.0%; P < .001 for trend) but remained stable after PCI for non-ST-segment elevation MI (1.6% to 1.6%; P = .18 for trend). Risk-adjusted CABG morality markedly decreased in patients with MI (5.6% to 3.4% for all CABG and 4.8% to 3.0% for isolated CABG) and in those without MI (2.8% to 1.7% for all CABG and 2.1% to 1.2% for isolated CABG) (P < .001 for all). CONCLUSIONS AND RELEVANCE Significant changes were found in the characteristics of patients undergoing PCI and CABG in the United States between 2003 and 2016. Risk-adjusted mortality decreased significantly after CABG but not after PCI across all clinical indications.
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Affiliation(s)
- Mohamad Alkhouli
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Fahad Alqahtani
- Division of Cardiology, Department of Medicine, University of Kentucky, Lexington
| | - Ankur Kalra
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Sameer Gafoor
- Swedish Heart and Vascular Institute, Seattle, Washington
| | | | | | - David R Holmes
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
| | - Amir Lerman
- Department of Cardiology, Mayo Clinic School of Medicine, Rochester, Minnesota
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Cepas-Guillén PL, Borrego-Rodriguez J, Flores-Umanzor E, Echarte-Morales J, Fernandez-Valledor A, Menendez-Suarez P, Vazquez S, Alonso N, Ortiz JT, Regueiro A, Iglesias I, Andrea R, Masotti M, Perez de Prado A, Brugaletta S, Bayón-Fernandez J, Freixa X, Fernandez-Vazquez F, Sabaté M. Outcomes of Nonagenarians With ST Elevation Myocardial Infarction. Am J Cardiol 2020; 125:11-18. [PMID: 31732135 DOI: 10.1016/j.amjcard.2019.09.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/24/2019] [Accepted: 09/26/2019] [Indexed: 10/25/2022]
Abstract
Although older adults are the fastest-growing age group among cardiovascular patients, nonagenarians with ST-segment elevation myocardial infarction (STEMI) are under-represented in clinical trials. The aims of this study are to analyze the clinical presentation and outcomes of nonagenarian patients presenting with STEMI and to compare in-hospital and 1-year clinical outcomes between those treated with optimal medical treatment alone and those receiving primary percutaneous coronary intervention (pPCI). We included all consecutive nonagenarians presenting with STEMI admitted in 2 academic centers between 2006 and 2018. There were no exclusion criteria. All-cause mortality was assessed in-hospital and at 1-year follow-up. In total, 167 patients (mean age 91.9 ± 0.17 years; 60% females) were included. Emergent catheterization was performed in 60% of our patients, and pPCI was performed in 50% (n = 83). Overall mortality was 22% in-hospital and 41% at 1-year follow-up. The pPCI group had lower mortality than the medical treatment group: 12% versus 32% in-hospital (p <0.01) and 26% versus 45% at 1-year follow-up (p <0.01), respectively. Multivariable analysis identified 4 independent predictors of all-cause mortality at 1 year: mechanical complications (adjusted odds ratio [OR] 9.25, p <0.01), Killip class III/IV (adjusted OR 4.22, p <0.01), serum creatinine at admission (mg/dl; adjusted OR 1.8, p <0.01), and pPCI (adjusted OR 0.52; p <0.05). In conclusion, STEMI in nonagenarians is becoming increasingly common. pPCI may be the preferred strategy in this high-risk cohort when a high grade of disability is not present. Hemodynamic compromise, the presence of complications related to myocardial infarction, renal impairment, and early revascularization may be related to prognosis in these patients.
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Alqahtani F, Balla S, AlHajji M, Chaudhary F, Albeiruti R, Kawsara A, Alkhouli M. Temporal trends in the utilization and outcomes of percutaneous coronary interventions in patients with liver cirrhosis. Catheter Cardiovasc Interv 2019; 96:802-810. [PMID: 31713989 DOI: 10.1002/ccd.28593] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 10/21/2019] [Accepted: 10/27/2019] [Indexed: 01/27/2023]
Abstract
OBJECTIVES We sought to assess the national trends in the utilization and outcomes of percutaneous coronary interventions (PCI) in patients with cirrhosis. BACKGROUND Contemporary data on PCI in patients with liver cirrhosis are limited. METHODS The National-Inpatient-Sample was used to identify patients who underwent PCI between 2003 and 2016. We examined the annual PCI rate, and compared the in-hospital morbidity, mortality, resource utilization, and cost following PCI in patients with and without cirrhosis. RESULTS A total of 8,860,178 PCI hospitalizations were identified, of those, 20,339 (0.2%) were performed in patients with cirrhosis. Annual PCI rates decreased overtime in patients without liver cirrhosis but increased in those with cirrhosis (Ptrend < .001). Patients with cirrhosis had a characteristic clinical, demographic, and socioeconomic profile compared with those without cirrhosis. The use of bare-metal stents decreased from 69.1 to 11.4% in the noncirrhosis group, and from 81.9 to 21.3% in the cirrhosis group. Compared with propensity-matched patients without cirrhosis, PCI in cirrhotic patients was associated with higher in-hospital mortality across all indications (STEMI 19.1 vs. 11.5%, p = .002; NSTEMI 8.7 vs. 5.6%, p = .002; and UA/SIHD 7.7 vs. 4.3%, p < .001). Cirrhotic patients also had significantly higher rates of acute kidney injury, but similar rates of vascular complications and stroke. Additionally, cirrhotic patients had longer hospitalizations, were less likely to be discharged home, and accrued higher cost across all PCI indications. CONCLUSIONS Patients with cirrhosis who are deemed "suitable PCI candidates" in current practice remain at high-risk for worse short-term morbidity and mortality, and higher cost of care.
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Affiliation(s)
- Fahad Alqahtani
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Sudarashan Balla
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Mohamed AlHajji
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Fahad Chaudhary
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Ridwaan Albeiruti
- Department of Medicine, West Virginia University, Morgantown, West Virginia
| | - Akram Kawsara
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
| | - Mohamad Alkhouli
- Division of Cardiology, West Virginia University, Morgantown, West Virginia
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Alkhouli M, Alqahtani F, Tarabishy A, Sandhu G, Rihal CS. Incidence, Predictors, and Outcomes of Acute Ischemic Stroke Following Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2019; 12:1497-1506. [DOI: 10.1016/j.jcin.2019.04.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/18/2019] [Accepted: 04/09/2019] [Indexed: 01/30/2023]
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Hakim R, Thuaire C, Saint-Etienne C, Marcollet P, Chassaing S, Dequenne P, Laure C, Gautier S, Akkoyun-Farinez J, Motreff P, Rangé G. [Non-ST elevation acute coronary syndrome: CRAC register experience]. Ann Cardiol Angeiol (Paris) 2018; 67:422-428. [PMID: 30391012 DOI: 10.1016/j.ancard.2018.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the clinical, angiographic, therapeutic and prognostic characteristics of nonagenarians presenting with non-ST elevation acute coronary syndrome with those of patients under 90 years of age. METHODS We used the CRAC register database including 6 catheterization laboratories in the Center Val-de-Loire region. Only patients with positive-troponin non-ST elevation ACS included in the registry from 2014 to 2017 were selected for epidemiological and procedural data. Regarding antiplatelet therapy, hospital and one-year follow-up data, only patients in the 2014-2015 period were analyzed. RESULTS From January 1st, 2014 to December 31st, 2017, 5.964 patients with a positive-troponin non-ST ACS, including 133 nonagenarians (2.2%) were included in the CRAC registry. Arterial hypertension and the history of coronary angioplasty were more common among nonagenarians. They present more multivessel and left main disease. The use of the bare metal stent was predominant in 2014-2015 and then became marginal in 2016-2017. Clopidogrel was the most widely used anti platelet and more than one in two nonagenarians remain on dual therapy after 12 months. One-year stroke and hospital and one-year mortality were higher in this age group. CONCLUSIONS Nonagenarians with a positive-troponin non-ST elevation ACS have more severe coronary artery disease and a poorer prognosis than those younger than 90 years of age.
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Affiliation(s)
- R Hakim
- Service de cardiologie, les hôpitaux de Chartres, Chartres, France
| | - C Thuaire
- Service de cardiologie, les hôpitaux de Chartres, Chartres, France
| | - C Saint-Etienne
- Service de cardiologie, centre hospitalo universitaire de Tours, 37170 Tours, France
| | - P Marcollet
- Service de cardiologie, centre hospitalier de Bourges, 18000 Bourges, France
| | - S Chassaing
- Service de cardiologie, clinique Saint-Gatien, 37000 Tours, France
| | - P Dequenne
- Service de cardiologie, clinique Oréliance, 45770 Saran, France
| | - C Laure
- Service de cardiologie, les hôpitaux de Chartres, Chartres, France
| | - S Gautier
- Service de cardiologie, les hôpitaux de Chartres, Chartres, France
| | | | - P Motreff
- Service de cardiologie, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - G Rangé
- Service de cardiologie, les hôpitaux de Chartres, Chartres, France.
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Mandawat A, Mandawat A. Chronological Age Is Just a Number When it Comes to Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2018; 11:1883-1884. [DOI: 10.1016/j.jcin.2018.07.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
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