1
|
Coronary Artery Bypass Surgery and Percutaneous Coronary Revascularization: Impact on Morbidity and Mortality in Patients with Coronary Artery Disease. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_26] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
2
|
Lee KH, Ahn Y, Kim SS, Rhew SH, Jeong YW, Jang SY, Cho JY, Jeong HC, Park KH, Yoon NS, Sim DS, Yoon HJ, Kim KH, Hong YJ, Park HW, Kim JH, Cho JG, Park JC, Jeong MH, Cho MC, Kim CJ, Kim YJ. Characteristics, in-hospital and long-term clinical outcomes of nonagenarian compared with octogenarian acute myocardial infarction patients. J Korean Med Sci 2014; 29:527-35. [PMID: 24753700 PMCID: PMC3991796 DOI: 10.3346/jkms.2014.29.4.527] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 02/10/2014] [Indexed: 11/20/2022] Open
Abstract
We compared clinical characteristics, management, and clinical outcomes of nonagenarian acute myocardial infarction (AMI) patients (n=270, 92.3 ± 2.3 yr old) with octogenarian AMI patients (n=2,145, 83.5 ± 2.7 yr old) enrolled in Korean AMI Registry (KAMIR). Nonagenarians were less likely to have hypertension, diabetes and less likely to be prescribed with beta-blockers, statins, and glycoprotein IIb/IIIa inhibitors compared with octogenarians. Although percutaneous coronary intervention (PCI) was preferred in octogenarians than nonagenarians, the success rate of PCI between the two groups was comparable. In-hospital mortality, the composite of in-hospital adverse outcomes and one year mortality were higher in nonagenarians than in octogenarians. However, the composite of the one year major adverse cardiac events (MACEs) was comparable between the two groups without differences in MI or re-PCI rate. PCI improved 1-yr mortality (adjusted hazard ratio [HR], 0.50; 95% confidence interval [CI], 0.36-0.69, P<0.001) and MACEs (adjusted HR, 0.47; 95% CI, 0.37-0.61, P<0.001) without significant complications both in nonagenarians and octogenarians. In conclusion, nonagenarians had similar 1-yr MACEs rates despite of higher in-hospital and 1-yr mortality compared with octogenarian AMI patients. PCI in nonagenarian AMI patients was associated to better 1-yr clinical outcomes.
Collapse
Affiliation(s)
- Ki Hong Lee
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Sung Soo Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Si Hyun Rhew
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Wook Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Soo Young Jang
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hae Chang Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Keun-Ho Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Nam Sik Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Doo Sun Sim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyun Joo Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Chungju, Korea
| | - Chong Jin Kim
- Department of Cardiovascular Medicine, East West Neo Medical Center, Seoul, Korea
| | - Young Jo Kim
- Department of Cardiovascular Medicine, Yeungnam University Hospital, Daegu, Korea
| | | |
Collapse
|
3
|
Rittger H, Schnupp S, Sinha AM, Breithardt OA, Schmidt M, Zimmermann S, Mahnkopf C, Brachmann J, Rieber J. Predictors of treatment in acute coronary syndromes in the elderly. Catheter Cardiovasc Interv 2012; 80:735-43. [PMID: 22121113 DOI: 10.1002/ccd.23426] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2011] [Accepted: 10/09/2011] [Indexed: 12/22/2022]
Affiliation(s)
- Harald Rittger
- Medizinische Klinik 2, Universitätsklinikum Erlangen, Erlangen, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Hong YJ, Jeong MH, Abizaid A, Banning A, Bartorelli A, Dzavik V, Ellis SG, Gao R, Holmes DR, Legrand V, Neumann FJ, Spaulding C, Worthley S, Urban P. Sirolimus-Eluting Coronary Stents in Octogenarians. JACC Cardiovasc Interv 2011; 4:982-91. [DOI: 10.1016/j.jcin.2011.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 06/14/2011] [Accepted: 06/28/2011] [Indexed: 01/16/2023]
|
5
|
Efficacy of Coronary Angioplasty on Long-Term Outcome in Elderly Chinese Patients with ST Elevated Myocardial Infarction. Cell Biochem Biophys 2010; 57:59-65. [DOI: 10.1007/s12013-010-9083-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
6
|
Hong YJ, Jeong MH, Choi YH, Ma EH, Ko JS, Lee MG, Park KH, Sim DS, Yoon NS, Youn HJ, Kim KH, Park HW, Kim JH, Ahn Y, Cho JG, Park JC, Kang JC. Age-related differences in virtual histology-intravascular ultrasound findings in patients with coronary artery disease. J Cardiol 2010; 55:224-31. [DOI: 10.1016/j.jjcc.2009.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 10/31/2009] [Accepted: 11/04/2009] [Indexed: 10/20/2022]
|
7
|
Agarwal S, Schechter C, Zaman A. Assessment of functional status and quality of life after percutaneous coronary revascularisation in octogenarians. Age Ageing 2009; 38:748-51. [PMID: 19755713 DOI: 10.1093/ageing/afp174] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
8
|
Morrison DA. It is never too late for PCI: To relieve medically refractory myocardial ischemia. Catheter Cardiovasc Interv 2009; 73:455-6. [PMID: 19235234 DOI: 10.1002/ccd.22004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
9
|
Hong YJ, Jeong MH, Ahn Y, Sim DS, Chung JW, Cho JS, Yoon NS, Yoon HJ, Moon JY, Kim KH, Park HW, Kim JH, Cho JG, Park JC, Kang JC. Age-Related Differences in Intravascular Ultrasound Findings in 1,009 Coronary Artery Disease Patients. Circ J 2008; 72:1270-5. [DOI: 10.1253/circj.72.1270] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital
| | - Youngkeun Ahn
- The Heart Center of Chonnam National University Hospital
| | - Doo Sun Sim
- The Heart Center of Chonnam National University Hospital
| | - Jong Won Chung
- The Heart Center of Chonnam National University Hospital
| | - Jung Sun Cho
- The Heart Center of Chonnam National University Hospital
| | - Nam Sik Yoon
- The Heart Center of Chonnam National University Hospital
| | - Hyun Ju Yoon
- The Heart Center of Chonnam National University Hospital
| | - Jae Youn Moon
- The Heart Center of Chonnam National University Hospital
| | - Kye Hun Kim
- The Heart Center of Chonnam National University Hospital
| | | | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital
| | | |
Collapse
|
10
|
Percutaneous coronary intervention in the elderly for myocardial infarction in the poststent era. Crit Pathw Cardiol 2007; 6:180-2. [PMID: 18091409 DOI: 10.1097/hpc.0b013e31815991e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients of > or =70 years of age and with acute coronary syndrome accumulate more risk factors with poor outcomes. Surgical revascularization is associated with increased mortality when compared with young population. The aim of this study was to communicate a single, small center experience, of percutaneous coronary intervention in the elderly in poststent era. PATIENTS AND METHODS Seventy-five consecutive patients, > or =70 years of age, with myocardial infarction (MI) at admission, between January, 2005 and November, 2006. We evaluate major and minor events during hospitalization. RESULTS Patients (64%) were male, 53.3% hypertension, 38.7% diabetes mellitus. Clinical presentation was: ST-segment elevation MI 53.3% and 5.3% with cardiogenic shock. Mean left ventricle ejection fraction was 48.5 +/- 18%. The procedure was successful in all the cases and culprit lesions received at least one stent in 93.4%. In-hospital major events were registered in 6.6% of cases: 3 (4%) death and 2 (2.6%) nonfatal MI; minor complications were registered in 5.2% of cases. CONCLUSION Percutaneous coronary intervention in patients >70 years of age during MI is feasible and safe, with low rates of complications.
Collapse
|
11
|
Han JH, Lindsell CJ, Hornung RW, Lewis T, Storrow AB, Hoekstra JW, Hollander JE, Miller CD, Peacock WF, Pollack CV, Gibler WB. The elder patient with suspected acute coronary syndromes in the emergency department. Acad Emerg Med 2007; 14:732-9. [PMID: 17567963 DOI: 10.1197/j.aem.2007.04.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES To describe the evaluation and outcomes of elder patients with suspected acute coronary syndromes (ACS) presenting to the emergency department (ED). METHODS This was a post hoc analysis of the Internet Tracking Registry for Acute Coronary Syndromes (i*trACS) registry, which had 17,713 ED visits for suspected ACS. First visits from the United States with nonmissing patient demographics, 12-lead electrocardiogram results, and clinical history were included in the analysis. Those who used cocaine or amphetamines or left the ED against medical advice were excluded. Elder was defined as age 75 years or older. ACS was defined by 30-day revascularization, Diagnosis-related Group codes, or death within 30 days with positive cardiac biomarkers at index hospitalization. Multivariable logistic regression analyses were performed to determine the association between being elder and 1) 30-day all-cause mortality, 2) ACS, 3) diagnostic tests ordered, and 4) disposition. Multivariable logistic regression was also performed to determine which clinical variables were associated with ACS in elder and nonelder patients. RESULTS A total of 10,126 patients with suspected ACS presenting to the ED were analyzed. For patients presenting to the ED, being elder was independently associated with ACS and all-cause 30-day mortality, with adjusted odds ratios of 1.8 (95% confidence interval [CI] = 1.5 to 2.2) and 2.6 (95% CI = 1.6 to 4.3), respectively. Elder patients were more likely to be admitted to the hospital (adjusted odds ratio, 2.2; 95% CI = 1.8 to 2.6), but there were no differences in the rates of cardiac catheterization and noninvasive stress cardiac imaging. Different clinical variables were associated with ACS in elder and nonelder patients. Chest pain as chief complaint, typical chest pain, and previous history of coronary artery disease were significantly associated with ACS in nonelder patients but were not associated with ACS in elder patients. Male gender and left arm pain were associated with ACS in both elder and nonelder patients. CONCLUSIONS Elder patients who present to the ED with suspected ACS represent a population at high risk for ACS and 30-day mortality. Elders are more likely to be admitted to the hospital, but despite an increased risk for adverse events, they have similar odds of receiving a diagnostic test, such as stress cardiac imaging or cardiac catheterization, compared with nonelder patients. Different clinical variables are associated with ACS, and clinical prediction rules utilizing presenting symptoms should consider the effect modification of age.
Collapse
Affiliation(s)
- Jin H Han
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Sardella G, De Luca L, De Persio G, Colantonio R, Petrolini A, Conti G, Fedele F. Benefits on coronary restenosis from elective paclitaxel-eluting stent implantation in patients aged 75 years and older. J Cardiovasc Med (Hagerstown) 2007; 8:494-8. [PMID: 17568281 DOI: 10.2459/01.jcm.0000278442.81741.d2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Elderly patients are increasingly referred for revascularisation yet have been underrepresented in some large clinical trials. Although the advent of drug-eluting stents has dramatically reduced clinical events related to restenosis, older age remains one of the most important correlates of adverse outcome, even after an elective percutaneous coronary intervention (PCI). We sought to evaluate the impact of paclitaxel-eluting stents on coronary restenosis in elderly patients undergoing elective PCI. METHODS Patients undergoing successful elective PCI with stenting of de novo coronary artery lesions were identified and screened for participation in this study. All patients included in our analysis were divided into two cohort groups: patients aged <75 years (younger cohort) and patients aged >or=75 years (elderly cohort). We evaluated the six-month incidence of target lesion revascularisation (TLR) and major adverse cardiac events, which included TLR, death and myocardial infarction. RESULTS A total of 171 (58 aged >or=75 years) consecutive patients were enrolled in the study. At six months, TLR rate was similar in both groups [1.77 vs. 1.72%, odds ratio (OR) 0.97, 95% confidence interval (CI) 0.08-10.9, P = 0.98, in the younger and elderly group, respectively]. Even the rate of major adverse cardiac events was comparable between the two groups (7.96 vs. 8.62%, OR 1.09, 95% CI 0.34-3.41, P = 0.88, in the younger and elderly group, respectively). Also the angiographic restenosis rates were comparable between patients <75 or >or=75 years (4.42 vs. 3.46%, P = 0.76). CONCLUSIONS After elective paclitaxel-eluting stent implantation, there is no difference in coronary restenosis in younger and elderly patients, suggesting an age-independent efficacy.
Collapse
Affiliation(s)
- Gennaro Sardella
- Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
13
|
Harpaz D, Rozenman Y, Behar S, Boyko V, Mandelzweig L, Gottlieb S. Coronary angiography in the elderly with acute myocardial infarction. Int J Cardiol 2007; 116:249-56. [PMID: 16839633 DOI: 10.1016/j.ijcard.2006.03.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Revised: 03/04/2006] [Accepted: 03/11/2006] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite the high mortality rate in elderly patients with acute myocardial infarction (AMI), the value of coronary angiography (CA) in the elderly has been questioned due to a less favorable outcome. The aim of the study was to determine the prognostic significance of CA on mortality of elderly patients AMI in "real world" practice. METHODS The study cohort comprised 1009 elderly (age > or = 75 years) patients with AMI who were derived from three prospective national surveys between 1996 and 2000 in all 25 CCUs operating in Israel. Baseline characteristics, hospital course, management and outcome of 274 (27%) elderly patients who underwent CA during the index hospitalization were compared with 735 (73%) counterpart patients who did not. RESULTS Patients who underwent CA were on average 2.2 years younger, and were more often with hyperlipidemia (p<0.0001 for each) and with a history of previous percutaneous coronary intervention (p<0.03) than the control group. They had a more favorable clinical presentation: a higher systolic blood pressure (p<0.04), a better Killip class (p<0.03) and an increased frequency of non-Q wave MI (p<0.03). They developed more often recurrent MI (p=0.002) and re-ischemia (p<0.0001). Variables associated with CA use during the index hospitalization were re-infarction, re-ischemia, the year of the index AMI and the availability of an on-site a catheterization laboratory in the hospital, while a higher age and fibrinolytic therapy decreased the likelihood of CA use. Of the patients who underwent CA, 67% underwent coronary revascularization (either PCI and/or CABG). Crude and adjusted mortality rates at 1 year were significantly lower in patients who underwent CA, as compared to counterparts who did not: 21% vs. 37.3%, respectively (p<0.0001), hazard ratio=0.52 (95% confidence interval 0.38-0.71). The benefit of CA was noted in a wide range of subgroups analyzed. CONCLUSIONS In "real world" practice, elderly patients with AMI who undergo CA during hospitalization have a better prognosis at 1 year. Age alone should not be a deterrent to performing CA in elderly patients with AMI. Further large randomized trials are needed to confirm that an invasive approach is beneficial in high-risk elderly patients with AMI. CONDENSED ABSTRACT To determine the prognostic significance of coronary angiography (CA) during the course of acute myocardial infarction (AMI) in "real world" practice on mortality of elderly patients, 1009 such patients were studied. Re-infarction, re-ischemia, the year of the index AMI and the availability of an on-site a Cath. Lab. were variables which increased the likelihood of undergoing CA, while a higher age and fibrinolytic therapy decreased this likelihood. The crude and covariate adjusted mortality rates at 1 year were significantly lower in patients who underwent CA in comparison to counterparts who did not: 21% vs. 37.3%, respectively (p<0.0001), hazard ratio 0.52 (95% confidence interval 0.38-0.71). The benefit of CA was noted across a wide range of subgroups analyzed.
Collapse
Affiliation(s)
- David Harpaz
- The Heart Institute, E. Wolfson Medical Center, Holon, 58-100, Israel.
| | | | | | | | | | | |
Collapse
|
14
|
Wilson JM, Ferguson JJ, Hall RJ. Coronary Artery Bypass Surgery and Percutaneous Coronary Revascularization: Impact on Morbidity and Mortality in Patients with Coronary Artery Disease. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_50] [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] Open
|
15
|
de Feyter PJ, de Jaegere PPT. Percutaneous Coronary Intervention for Unstable Coronary Artery Disease. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
16
|
Wiviott SD, Giugliano RP. Non ST-Elevation Acute Coronary Syndromes. Cardiovasc Ther 2007. [DOI: 10.1016/b978-1-4160-3358-5.50016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
17
|
García-Pinilla JM, Jiménez-Navarro MF, Gómez Doblas JJ, Alonso JH, Hernández García JM, de Teresa Galván E. [Therapeutic attitude after coronariography in elderly patients with ischemic heart disease]. Rev Clin Esp 2006; 205:595-600. [PMID: 16527181 DOI: 10.1016/s0014-2565(05)72652-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The incidence of ischemic heart disease in the elderly is high. These patients are increasing referred for coronariography. OBJECTIVES Identify factors associated with coronary revascularization in elderly patients. MATERIAL AND METHODS Retrospective study of 473 patients > or = 75 years who underwent coronariography in relationship with ischemic heart disease. Their clinical-epidemiological characteristics and treatment adopted were analyzed. A multivariate analysis model was used to identify factors associated with revascularization. RESULTS Mean age was 77.6 +/- 2.8 years; 70.4% were men. A total of 36% smoked, 53% were hypertensive, 33% diabetics and 30% dislipidemic. Thirty one % had multivessel disease and 11% involvement of left coronary trunk. There was evidence of anterior descending artery in 68%. Medical treatment was done in 48.4%, percutaneous revascularization in 41.5% and surgical in 10.1%. Patients with lesions of the anterior descending artery were revascularized in greater proportion: 67.7% vs 32.3%; p. 0.001. A logistic regression model was used to identify revascularization predictors, obtaining a direct relationship with the involvement of the anterior descending artery (OR: 4.87; 95% CI: 2.98-7.94; (p < 0.001) and inverse on with the previous revascularization (OR: 0.47; 95% CI: 0.26-0.85; p < 0.02), left ventricular dysfunction (OR: 0.58; 95% CI: 0.39-0.88; p = 0.01) and presence of multivessel disease (OR: 0.51; 95% CI: 0.31-0.84; p < 0.01). CONCLUSIONS The elderly subjects with ischemic heart disease who underwent coronariography received revascularizing treatment in somewhat more than 50% of the cases. A direct relationship was found between involvement of the anterior descending artery and performance of revascularizing treatment and an inverse on between previous revascularization, left ventricular dysfunction and presence of multivessel disease.
Collapse
Affiliation(s)
- J M García-Pinilla
- Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga.
| | | | | | | | | | | |
Collapse
|
18
|
Liistro F, Angioli P, Falsini G, Ducci K, Baldassarre S, Burali A, Bolognese L. Early invasive strategy in elderly patients with non-ST elevation acute coronary syndrome: comparison with younger patients regarding 30 day and long term outcome. Heart 2005; 91:1284-8. [PMID: 15761051 PMCID: PMC1769133 DOI: 10.1136/hrt.2004.051607] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To evaluate an early invasive strategy in elderly patients with non-ST elevation acute coronary syndrome (ACS). METHODS All consecutive patients admitted with a diagnosis of non-ST elevation ACS from June 2002 to February 2004 were enrolled in this registry. Clinical outcome was assessed at 30 days and in long term follow up. RESULTS An early invasive strategy was followed for 439 patients, of whom 159 (36%) were elderly and had a higher clinical risk profile and greater extent of coronary artery disease (CAD) than the younger patients. Coronary revascularisation was conducted in 133 (83%) elderly patients and 239 (85%) younger patients (not significant). At a mean (SD) follow up time of 10.7 (5.2) months overall mortality, cardiac death, and death plus myocardial infarction were significantly higher among elderly patients than among younger patients (9.4% v 2.1%, p < 0.001; 6.8% v 1.8%, p < 0.01; 11.3% v 5%, p = 0.02, respectively). The significant difference in cardiac death between the two groups was related more to elderly patients being treated by coronary artery bypass grafting (19.3% v 4.9%, p = 0.05) than by percutaneous coronary intervention (PCI) (2.9% v 1.1%, p = 0.3). Cox regression analysis showed age, serum creatinine > 115 micromol/l, no previous history of CAD, left ventricular ejection fraction > 45%, and the absence of diabetes to be independent predictors of the occurrence of major adverse cardiac events. CONCLUSIONS In unselected elderly patients presenting with non-ST elevation ACS an early invasive strategy is feasible and leads to coronary revascularisation in the majority of cases, resulting in encouraging immediate and long term clinical results, particularly among PCI treated patients.
Collapse
Affiliation(s)
- F Liistro
- Department of Cardiovascular Disease, San Donato Hospital, 52100 Arezzo, Italy.
| | | | | | | | | | | | | |
Collapse
|
19
|
De Servi S, Cavallini C, Dellavalle A, Santoro GM, Bonizzoni E, Marzocchi A, Politi A, Pesaresi A, Mariani M, Chierchia S. Non-ST-elevation acute coronary syndrome in the elderly: treatment strategies and 30-day outcome. Am Heart J 2004; 147:830-6. [PMID: 15131538 DOI: 10.1016/j.ahj.2003.12.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The purpose of this study was to assess the current care of elderly patients with non-ST-elevation acute coronary syndrome (ACS), with particular regard to the rate of use of antiplatelet drugs and the type of strategy, aggressive or conservative, in a population of consecutive patients admitted to 76 Coronary Care Units in Italy. METHODS Prospective registry of patients admitted to Coronary Care Units with a diagnosis of non-ST-elevation ACS during a 2-month period. Thirty-day follow-up was available in all patients. RESULTS Of 1581 patients enrolled in the registry, 564 were 75 years or older. As compared with the 1017 younger patients, elderly patients had a greater prevalence of female sex (42% vs 27%, P <.001), hypertension (70% vs 59%, P <.001), prior myocardial infarction (MI) (41% vs 29%, P <.001), prior angina (18% vs 13%, P <.01), prior use of aspirin (49% vs 39%, P <.001), ST-segment depression (54% vs 43%, P <.001), and troponin positivity (66% vs 59%, P <.05). The higher-risk profile of elderly patients was confirmed by the greater number of patients with a high TIMI risk score (37% vs 22%, P <.001). GPIIb/IIIa inhibitors were less frequently used in elderly patients (P <.05). An aggressive strategy (coronary arteriography within 4 days of admission, followed by revascularization, if feasible) was adopted in 39% elderly patients and in 56% younger patients (P <.001). An interventional procedure within 30 days was performed in 30% of elderly patients and 48% of younger patients (P <.001). Elderly patients had a more unfavorable 30-day outcome compared with younger ones, as shown by the higher rates of death (6.4% vs 1.7%), acute myocardial infarction (7.1% vs 5%), and stroke (1.3% vs 0.5%). Multivariate analysis of the elderly group identified a conservative strategy (OR, 2.31; 95% CI, 1.20 to 4.48) and a diagnosis of non-Q-wave MI (OR, 2.27; 95% CI, 1.32 to 3.93) as independent predictors of 30-day events. CONCLUSIONS The elderly represent a very high-risk subgroup among patients with non-ST-elevation ACS, with a nearly 4-fold as high 30-day death rate as that of younger patients. These data call for a greater attention to such population, both in terms of an improved representation in clinical research and of the assessment of the outcome of different strategies in appropriately designed randomized trials.
Collapse
Affiliation(s)
- Stefano De Servi
- Unita' Operativa di Cardiologia, Ospedale Civile di Legnano, Legnano, Milan, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Best PJM, Berger PB. Can percutaneous coronary interventions reduce death and myocardial infarction in stable and unstable coronary disease? Catheter Cardiovasc Interv 2004; 61:528-36. [PMID: 15065151 DOI: 10.1002/ccd.20016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Patricia J M Best
- Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 27715, USA
| | | |
Collapse
|
21
|
Niebauer J, Sixt S, Zhang F, Yu J, Sick P, Thiele H, Lauer B, Schuler G. Contemporary outcome of cardiac catheterizations in 1085 consecutive octogenarians. Int J Cardiol 2004; 93:225-30. [PMID: 14975551 DOI: 10.1016/s0167-5273(03)00216-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2003] [Indexed: 11/26/2022]
Abstract
BACKGROUND A growing number of patients > or = 80 years require cardiac catheterization. Since little is known about the overall safety of these procedures in this population, we assessed the procedure-related risks and determined predictors for complications. METHODS We studied 1085 consecutive patients > or = 80 years (82.6+/-2.6 years; 526 males, 544 females), who underwent 1384 cardiac catheterizations in a tertiary specialist university hospital (3% of 43,517 procedures). RESULTS A total of 373 patients (35%) required percutaneous coronary interventions (PCI), and 331 (31%) received coronary artery bypass surgery. Thirty-one patients died during hospital stay. Procedure-related complications including vascular injuries occurred in 2.1% after CATH and 11.6% after PCI. CONCLUSIONS Despite the widespread notion that cardiac catheterization exposes patients > or = 80 years to an unwarranted risk, these data demonstrate an acceptable complication rate. Patients #10878;80 years of age should thus not be refused to undergo cardiac catheterization merely based on their age.
Collapse
Affiliation(s)
- Josef Niebauer
- Abteilung für Innere Medizin/Kardiolgie, Universität Leipzig-Herzzentrum GmbH, Strümpellstr. 39, 04289 Leipzig, Germany.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Dynina O, Vakili BA, Slater JN, Sherman W, Ravi KL, Green SJ, Sanborn TA, Brown DL. In-hospital outcomes of contemporary percutaneous coronary interventions in the very elderly. Catheter Cardiovasc Interv 2003; 58:351-7. [PMID: 12594701 DOI: 10.1002/ccd.10437] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Coronary heart disease is the leading cause of death among the elderly (> 65 years) and the very elderly (> 85 years). Little information is available regarding the outcome of very elderly patients referred for PCI in the current era of improved techniques, devices, and pharmacotherapy. The objective of the current study was to evaluate the clinical characteristics and outcomes of very elderly patients > or = 85 years of age in a large, contemporary, multi-institutional PCI database. Five hospitals in the New York City metropolitan area contributed these prospectively defined data elements on consecutive patients undergoing PCI from 1 January 1998 to 1 October 1999. Of 10,847 patients, 5,341 (49%) were younger than 65 years, 3,342 (31%) were 65-74 years, 1,885 (17%) were 75-84 years, and 279 (2.6%) were at least 85 years of age. Following PCI, the very elderly developed stroke (P < 0.001) and renal failure requiring dialysis (P = 0.002) more commonly than younger patients following PCI. The very elderly had a significantly increased in-hospital mortality rate at 2.5% (P < 0.001). However, on multivariate analysis, age > or = 85 years was not an independent predictor of in-hospital mortality (OR = 1.22; 95% CI = 0.37-4.07). The very elderly should not be refused PCI on the basis of advanced age alone.
Collapse
Affiliation(s)
- Olga Dynina
- Department of Medicine (Cardiology), Albert Einstein College of Medicine, Bronx, New York 10003, USA
| | | | | | | | | | | | | | | |
Collapse
|
23
|
Voudris VA, Skoularigis JS, Malakos JS, Kourgianides GC, Pavlides GS, Manginas AN, Kolovou GD, Cokkinos DV. Long-term clinical outcome of coronary artery stenting in elderly patients. Coron Artery Dis 2002; 13:323-9. [PMID: 12436027 DOI: 10.1097/00019501-200209000-00004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The elderly constitute a rapidly expanding segment of our population and cardiovascular disease becomes more prevalent with increasing age. Existing data have shown that percutaneous coronary interventions in the elderly are associated with an increase risk of in-hospital complications compared to younger patients. In the present study we retrospectively assessed the long-term clinical outcome of coronary artery stenting in an elderly population and compared them with the cohort of younger patients. METHODS The study population included 402 consecutive patients with coronary artery disease who underwent coronary artery stenting; of these 69 were elderly (age > 70 years, group I) and 333 were younger (age <or= 70 years, group II). Percutaneous coronary intervention combined with stent implantation was performed using standard techniques. Clinical outcomes during follow-up (24 +/- 13 months, range 7-56 months) were obtained in all patients without major in-hospital complications. Survival curves and multivariate Cox proportional hazard models for any late clinical event were reported. RESULTS No difference in in-hospital complications or clinical success rate was observed between the two groups of patients. Complete revascularization was obtained more frequently in younger compared to elderly patients (P < 0.05). At 2 years, event-free survival was 62% in the elderly and 76% in younger patients (P < 0.001); this difference was mostly made-up by recurrence of angina in the elderly. Impaired left ventricular systolic function (ejection fraction < 40%) was an independent predictor of late death. CONCLUSIONS Coronary artery stenting is an effective therapeutic strategy in elderly with coronary artery disease and is associated with good short- and long-term results. Age per se should not preclude patients from undergoing coronary stenting.
Collapse
Affiliation(s)
- Vassilis A Voudris
- First Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Graham MM, Ghali WA, Faris PD, Galbraith PD, Norris CM, Knudtson ML. Survival after coronary revascularization in the elderly. Circulation 2002; 105:2378-84. [PMID: 12021224 DOI: 10.1161/01.cir.0000016640.99114.3d] [Citation(s) in RCA: 236] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Elderly patients with ischemic heart disease are increasingly referred for coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). However, reports of poor outcomes in the elderly have led to questions about the benefit of these strategies. We studied survival by prescribed treatment (CABG, PCI, or medical therapy) for patients in 3 age categories: <70 years, 70 to 79 years, and > or =80 years of age. METHODS AND RESULTS The Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) is a clinical data collection and outcome monitoring initiative capturing all patients undergoing cardiac catheterization and revascularization in the province of Alberta, Canada, since 1995. Characteristics and long-term outcomes of a cohort of >6000 elderly patients with ischemic heart disease were compared with younger patients. In 15 392 patients >70 years of age, 4-year adjusted actuarial survival rates for CABG, PCI, and medical therapy were 95.0%, 93.8%, and 90.5%, respectively. In 5198 patients 70 to 79 years of age, survival rates were 87.3%, 83.9%, and 79.1%, respectively. In 983 patients > or = 80 years of age, survival was 77.4% for CABG, 71.6% for PCI, and 60.3% for medical therapy. Absolute risk differences in comparison to medical therapy for CABG (17.0%) and PCI (11.3%) were greater for patients > or =80 years of age than for younger patients. CONCLUSIONS Elderly patients paradoxically have greater absolute risk reductions associated with surgical or percutaneous revascularization than do younger patients. The combination of these results with a recent randomized trial suggests that the benefits of aggressive revascularization therapies may extend to subsets of patients in older age groups.
Collapse
|
25
|
Himbert D. [Unstable angina in the elderly]. Ann Cardiol Angeiol (Paris) 2001; 50:397-403. [PMID: 12555632 DOI: 10.1016/s0003-3928(01)00046-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Unstable angina and acute coronary syndromes without persistent ST-segment elevation are frequent and their prognosis is poor in the elderly. Indeed, age is the most powerful predictor of in-hospital mortality in this setting. The clinical benefit of interventional strategies, as demonstrated by FRISC II and TACTICS TIMI 18 studies, seems to be most important in this age subset. PURSUIT trial demonstrates that the efficacy of eptifibatide, a IIb/IIIa platelet receptor inhibitor, increases in elderly patients who simultaneously undergo revascularization interventions. Individual application of such treatment strategies may be difficult. Potential triggering factors of unstable angina and comorbidities have to be taken into account, and the overall management should be highly individualized in elderly patients. The aim remains to achieve appropriate myocardial revascularization, as often as possible by focusing coronary angioplasty on the culprit vessel. Coronary surgery generally should be reserved for coronary lesions which are not suitable for percutaneous revascularization. Clinical improvement is maximal in patients with severe initial presentation.
Collapse
Affiliation(s)
- D Himbert
- Service de cardiologie, groupe hospitalier Bichat-Claude Bernard, 46, rue Henri Huchard, 75018 Paris, France.
| |
Collapse
|
26
|
Torre Hernández JMDL, Fernández-Valls M, Royuela N, Gómez González I, Enríquez SG, Zueco J, Figueroa Á, Colman T. Angina inestable en el paciente octogenario: ¿es factible y eficaz el abordaje invasivo? Rev Esp Cardiol (Engl Ed) 2001. [DOI: 10.1016/s0300-8932(01)76382-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
27
|
Bermejo García J, López de Sá E, López-Sendón JL, Pabón Osuna P, García-Morán E, Bethencourt A, Bosch Genover X, Roldán Rabadán I, Calviño Santos R, Valle Tudela V. [Unstable angina in the elderly: clinical, profile, management and mortality at three months. The PEPA Registry Data]. Rev Esp Cardiol 2000; 53:1564-72. [PMID: 11171478 DOI: 10.1016/s0300-8932(00)75281-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION AND OBJECTIVES Few reports in the literature have studied the characteristics and management of unstable angina in the elderly in Spain. The aim of this study was to analyze the clinical characteristics and the use of diagnostic and therapeutic resources in patients > or = 70 years of age. PATIENTS AND METHODS A total of 1,551 patients > or = 70 years of age were included out of 4,115 included in the PEPA registry with a follow up of 90 days. These patients were compared with 2,564 < 70 years. RESULTS In comparison, the elderly (76 +/- 5 years) versus the younger group (58 +/- 8.5 years) included a higher proportion of women (43 vs 27%), diabetics (30 vs 23%)and hypertensive patients (60 vs 49%) with a lower proportion (p < 0.001) of hypercholesterolemia (33 vs 43%), smoking (40 vs 60%) or family history (9 vs 17%). A previous history of angina (49 vs 35%) or infarction (38 vs31%) and comorbidity was found to be significantly more frequent in the elderly, with a worse previous functional class (NYHA > 2 out of 34 vs 15%). The elderly were treated with fewer invasive procedures (25 vs 44%) or catheterization (26 vs 36%) and they were more frequently controlled with medical treatment (86 vs 83%) although with a lower use of beta blockers (45 vs 53%). The mortality at 3 months was greater in the elderly (7.4 vs 3.0%;p < 0.005) with age being an independent predictor of bad prognosis. Cox multivariate analysis showed the age, ST segment depression, diabetes and heart failure on admission to be predictors of bad prognosis in the elderly. CONCLUSIONS A different pattern is observed in cardiovascular risk factors with a more unfavorable clinical profile in elderly patients with unstable angina. The management of these patients is less aggressive and the mortality is greater. Diabetes, heart failure and ST segment depression on admission are independent predictors of bad prognosis in elderly patients.
Collapse
|
28
|
Braunwald E, Antman EM, Beasley JW, Califf RM, Cheitlin MD, Hochman JS, Jones RH, Kereiakes D, Kupersmith J, Levin TN, Pepine CJ, Schaeffer JW, Smith EE, Steward DE, Theroux P, Alpert JS, Eagle KA, Faxon DP, Fuster V, Gardner TJ, Gregoratos G, Russell RO, Smith SC. ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina). J Am Coll Cardiol 2000; 36:970-1062. [PMID: 10987629 DOI: 10.1016/s0735-1097(00)00889-5] [Citation(s) in RCA: 561] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
|
29
|
Affiliation(s)
- H Hirsch
- Division of Cardiology, Winthrop-University Hospital, SUNY at Stony Brook 11501, USA
| | | | | | | |
Collapse
|
30
|
Abizaid AS, Mintz GS, Abizaid A, Saucedo JF, Mehran R, Pichard AD, Kent KM, Satler LF, Leon MB. Influence of patient age on acute and late clinical outcomes following Palmaz-Schatz coronary stent implantation. Am J Cardiol 2000; 85:338-43. [PMID: 11078303 DOI: 10.1016/s0002-9149(99)00743-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Procedural success may be lower and complication rates higher after balloon angioplasty in older patients. Elective stent implantation improves procedural outcome in younger patients; however, few series have specifically analyzed the octogenarian population. Therefore, we studied 2,534 consecutive patients (3,965 native coronary artery stenoses) who were treated electively with Palmaz-Schatz stents and divided them into 3 groups: (1) < or = 70 years old (n = 1,805), (2) 71 to 80 years old (elderly, n = 607), and (3) > 80 years old (octogenarian, n = 122). Major in-hospital complications (death, myocardial infarction, and urgent bypass surgery) were significantly higher in the octogenarians than in the elderly and patients < or = 70 years of age (4.5% vs 2.0% and 1.5%; p = 0.001). At 1-year follow-up, cardiac events (death, nonfatal myocardial infarction, and need for any revascularization) did not differ among groups; however, there was a stepwise increase in late death in octogenarians (5%) compared with elderly patients (2%) and patients aged < or = 70 years (1%) (p = 0.001). Target lesion revascularization was similar among the groups (11% in octogenarian vs 14% in elderly and 15% in patients < or = 70 years, p = 0.791). By multivariate logistic regression analysis, age was an independent predictor of late mortality (odds ratio 1.05, p = 0.0001), but not a predictor of target lesion revascularization. Stent implantation in octogenarians is associated with (1) more acute complications, (2) a higher in-hospital mortality, (3) a higher late mortality, and (4) a target lesion revascularization similar to younger patients.
Collapse
Affiliation(s)
- A S Abizaid
- Cardiac Catheterization Laboratories, Washington Hospital Center, DC, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Luengo CM. Angina inestable en el anciano: ¿están justificadas las diferencias en las estrategias diagnósticas y terapéuticas? El concepto del «viejo joven» y el «viejo viejo». Rev Esp Cardiol (Engl Ed) 2000. [DOI: 10.1016/s0300-8932(00)75173-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
32
|
Tascón Pérez JC, González-Trevilla AA, Gutiérrez MA, Dussac JA, Hernández Hernández F, Sánchez Sánchez V, Rodríguez García J. [The therapeutic focus in severe hypertrophic obstructive cardiomyopathy with multivessel coronary disease]. Rev Esp Cardiol 1999; 52:343-7. [PMID: 10368586 DOI: 10.1016/s0300-8932(99)74925-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The association of severe hypertrophic obstructive cardiomyopathy and coronary artery disease increases surgical morbimortality, even more in patients over 65 years. We describe a combined therapeutic approach to these diseases. A 68-year-old woman with a diagnosis of hypertrophic obstructive cardiomyopathy was in functional class IV for angina and dyspnea despite 360 mg of propranolol a day. An echocardiogram and a complete cardiac catheterization were performed under betablocker therapy, confirming a severe hypertrophic obstructive cardiomyopathy and revealing severe stenosis in the proximal left circumflex and the proximal right coronary arteries, and a moderate lesion in the mid-left anterior descendent. They were both treated with balloon PTCA, and a 3 x 15 mm stent was placed in the circumflex and a 3.5 x 20 mm stent in the right coronary, with an excellent angiographic result. A basal hemodynamic study was then performed and A-V sequential pacing was attempted, achieving a significant decrease in the left ventricle outflow tract gradient. A DDD-R pacemaker was implanted. Echocardiographic study was performed post-implantation, and follow-up was made six months later with a new coronary angiography, hemodynamic study and a Doppler echocardiogram. At the present time A-V sequential pacing as a therapeutic option for hypertrophic obstructive cardiomyopathy and coronary angioplasty and stenting for the treatment of coronary artery disease are sufficiently established and supported to be offered as a combined therapy to patients suffering from both diseases, specially those with a higher surgical risk.
Collapse
Affiliation(s)
- J C Tascón Pérez
- Servicio de Cardiología, Hospital Universitario 12 de Octubre, Madrid
| | | | | | | | | | | | | |
Collapse
|
33
|
Mortasawi A, Ennker IC, Albert A, Rosendahl U, Dalladaku F, Alexander T, Ennker J. [Arterial myocardial revascularization in the 9th decade of life. Personal results and review of the literature]. Herz 1999; 24:158-70. [PMID: 10372302 DOI: 10.1007/bf03043855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The rate of the population being 80 years of age and even older, has an increasing tendency in the Federal Republic of Germany. In 1996, a total of 87,372 patients received surgery supported by the heart-lung-machine, 2,383 patients out of these (2.7%) were 80 years of age and older. In view of the limited life expectance, the arterial revascularization in this age category is faced with controverse discussions. We analysed our patients in relation to this aspect. Between January 1, 1995 and June 30, 1997, 4,338 patients underwent surgery supported by the heart-lung-machine. Hundred and fifty-five out of these (3.6%) were in the 9th decade of life. Seventy-seven patients out of the 155 (49.7%, 34 women, 43 men, 80 to 88 years old, mean: 82 years of age) underwent an isolated myocardial revascularization. We performed 55 (71%) elective, 16 (21%) urgent and 6 (8%) emergency surgeries. Twelve patients (15.6%) solely received venous bypasses (Group I), 65 (84.4%) additionally also received unilateral bypasses of the internal mammaria artery (IMA) (Group II). Three patients died at our facility (3.9%), 3 further patients died during the follow-up treatment in outlying hospitals, the in-patient mortality rate in Group I therefore presented a rate of 8.3%, in Group II 7.7% and in total, a rate of 7.8%. In 1996, the in-patient mortality rate could be reduced to 3.6%. The follow-up observation time ranged between 7 and 138 weeks (median 44 weeks). The survival rate for patients with an IMA-bypass after 1 year was 86.3%, after 2 years 77%, and for the entire collective 85.3% and 75%. Whereas 96% of the patients could pre-operatively be related to Class III or IV of the NYHA-classification, 55 of the 63 survivors (87%) belonged to Class I (6%) or II (81%). Two Group I patients (22.2%), 3 Group II patients (5.6%) and 7.9% of the total collective complained about repeated angina symptoms. The myocardial revascularization with the internal mammaria artery performed on patients in the 9th decade of life, achieves an acceptable morbidity and mortality compared to solely venous coronary bypasses. The more prolonged follow-up observation period will clarify, whether the arterial myocardial revascularization also proves to be the superior method in this age category.
Collapse
Affiliation(s)
- A Mortasawi
- Klinik für Herz-, Thorax- und Gefässchirurgie, Herzzentrum Lahr/Baden.
| | | | | | | | | | | | | |
Collapse
|
34
|
Halon DA, Flugelman MY, Merdler A, Rennert H, Shahla J, Lewis BS. Long-term (10-year) outcome in patients with unstable angina pectoris treated by coronary balloon angioplasty. J Am Coll Cardiol 1998; 32:1603-9. [PMID: 9822085 DOI: 10.1016/s0735-1097(98)00450-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES We sought to examine completed 10-year survival and event-free survival in patients with stable and unstable angina pectoris treated by coronary balloon angioplasty. BACKGROUND Patients with unstable angina are at increased risk for recurrent acute coronary events. METHODS The study included 208 consecutive patients (133 with stable and 75 with unstable angina pectoris) undergoing angioplasty from 1984 to 1986. The balloon crossed the lesion in 185 patients (121 with stable and 64 with unstable angina pectoris). Angioplasty was performed in patients with unstable angina pectoris 12+/-15 days (median 8) after symptom onset. Patients with unstable angina pectoris were classified retrospectively into Braunwald class I (n=3), class II (n=20), class III (n=28), class B (n=52) and class C (n=12). Follow-up data were obtained from hospital charts, telephone interview and official death certificates where applicable. The study had >80% power to detect a clinically significant 20% difference in survival and a 20% difference in event-free survival between the stable and unstable patient groups. RESULTS Despite similar baseline characteristics, early (40-day) mortality was slightly higher in patients with unstable angina (4.7% [3 of 64 patients] vs. 0.8% [1 of 121 patients], p=NS). Long-term outcome was not different, because survival curves were parallel thereafter (10-year survival was 83% for those with stable and 77% for those with unstable angina, p=NS). Survival free of myocardial infarction or coronary artery bypass graft surgery at 10 years was 53% in patients with stable and 47% in patients with unstable angina (p=NS), and survival free of infarction, bypass surgery or repeat angioplasty was 32% for both groups at 10 years. In patients with Braunwald class III unstable angina, 10-year survival was 80%, as compared with 85% in other patients with unstable angina, due to the early hazard (p=NS). Survival and event-free survival were similar in patients who had had a recent myocardial infarction (Braunwald class C) and in patients with acute electrocardiographic changes. Repeat hospital admissions were not more frequent in patients with unstable angina (3.1+/-3.5 vs. 3.0+/-2.6, p=NS). CONCLUSIONS Ten-year survival and event-free survival were similar in patients with stable and unstable angina pectoris treated by coronary balloon angioplasty, with no evidence of an increased rate of recurrent cardiovascular events in the unstable group.
Collapse
Affiliation(s)
- D A Halon
- Department of Cardiology, Lady Davis Carmel Medical Center, Technion-IIT, Haifa, Israel
| | | | | | | | | | | |
Collapse
|
35
|
De Gregorio J, Kobayashi Y, Albiero R, Reimers B, Di Mario C, Finci L, Colombo A. Coronary artery stenting in the elderly: short-term outcome and long-term angiographic and clinical follow-up. J Am Coll Cardiol 1998; 32:577-83. [PMID: 9741496 DOI: 10.1016/s0735-1097(98)00287-3] [Citation(s) in RCA: 101] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study sought to compare the short- and long-term outcomes of elderly patients undergoing coronary artery stenting with those of younger patients and to determine the long-term clinical outcome and survival of elderly patients post stent implantation. BACKGROUND Elderly patients undergoing coronary revascularization are considered a high-risk group. Few data exist that relate the results of stenting in treating coronary artery disease in the elderly population. METHODS All elderly patients >75 years of age who underwent coronary artery stenting between March 1993 and July 1997 (n=137) at our center were compared to the patients <75 who underwent coronary artery stenting during the same time period (n=2,551). Long-term clinical follow-up and survival were determined for the elderly group. RESULTS Elderly patients presented with lower ejection fractions (54% vs. 58%, p=0.0001), more unstable angina (47% vs. 28%, p=0.0001), and more multivessel disease (78% vs. 62%, p= 0.0001) than younger patients. These older patients had higher rates of procedure related complications including procedural myocardial infarction (MI) (2.9% vs. 1.7%, p=0.2), emergency CABG (3.7% vs. 1.4%, p=0.04), and death (2.2% vs. 0.12%, p=0.0001). Angiographic follow-up, obtained in both groups, demonstrated significantly higher restenosis rates in the elderly versus younger patients (47% vs. 28%, p=0.0007). Longer term clinical follow-up, which was obtained only in the elderly group, showed that at a mean follow-up period of 12 months post coronary stenting, elderly survival free from death, MI, revascularization and angina was 54% and that their overall survival was 91%. Subanalysis of the elderly patients who died showed much higher incidence of combined unstable angina (80%), prior MI (60%), lower ejection fraction (46%), multivessel disease (100%) and complex lesions (100%) than the overall group. CONCLUSIONS Elderly patients who undergo coronary artery stenting have significantly higher rates of procedural complications and worse six month outcomes than younger patients, especially those who present with combined unstable angina, history of MI, EF < 50%, multivessel disease and complex lesions. Overall survival in the elderly population at 12 months postcoronary artery stenting was 91% and event-free survival was 54%.
Collapse
|