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Fadah K, Hechanova A, Mukherjee D. Epidemiology, Pathophysiology, and Management of Coronary Artery Disease in the Elderly. Int J Angiol 2022; 31:244-250. [PMID: 36588871 PMCID: PMC9803549 DOI: 10.1055/s-0042-1751234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Elderly patients over the age of ≥ 75 years are especially susceptible to coronary artery disease (CAD) as age is an important nonmodifiable risk factors for atherosclerosis and a predictor of poorer outcomes. In fact, CAD is a major cause of mortality and morbidity in this population. Due to concerns of functional frailty, comorbidities, and patient preference of conservative to no treatment have played a role in reducing the interest in pursuing prospective studies in this high-risk group. In this review, we provide an overview of the epidemiology, pathophysiology, and management of CAD in older adults.
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Affiliation(s)
- Kahtan Fadah
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Aimee Hechanova
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
| | - Debabrata Mukherjee
- Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, Texas
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2
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Tkacheva ON, Vorobyeva NM, Kotovskaya YV, Runikhina NK, Strazhesco ID, Villevalde SV, Drapkina OM, Komarov AL, Orlova YA, Panchenko EP, Pogosova NV, Frolova EV, Yavelov IS. Antithrombotic therapy in the elderly and senile age: the consensus opinion of experts of the Russian Association of Gerontologists and Geriatricians and the National Society of Preventive Cardiology. КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2021. [DOI: 10.15829/1728-8800-2021-2847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
В данном документе обсуждаются особенности АТТ у лиц пожилого и старческого возраста в различных клинических ситуациях.
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Morttada A, Shahin S. Incidence and predictors of bleeding among Egyptian patients presenting with acute coronary syndrome: Using CRUSADE risk score. Egypt Heart J 2018; 70:135-142. [PMID: 30190637 PMCID: PMC6123232 DOI: 10.1016/j.ehj.2018.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/20/2018] [Indexed: 11/28/2022] Open
Abstract
Background Early invasive strategies; in management of acute coronary syndrome; has led to improvement of patient outcomes. However, these invasive therapies have their own risks, namely bleeding and blood transfusion. The aim of this study was to determine the incidence of bleeding, its location and severity among the study population, to correlate between the patients' characteristics and the risk profile of the patients based upon the CRUSADE risk score and increased bleeding events, and lastly; to identify the predictors of increased bleeding risk among Egyptian patients who presented with acute coronary syndrome. Methods The study had included eight hundred and twenty-three patients referred to coronary care unit (CCU), to (Ain Shams University hospital, Specialized Ain Shams hospital, and 6th October insurance hospital) with diagnosis of Acute Coronary Syndrome “ACS” within a period from 1/2014 till 7/2014, and they were followed up for additional three months following discharge with assessment of their bleeding risk and risk scores. Results More bleeding events had been witnessed among the study population who were older, diabetics, had renal impairment, had peripheral vascular disease, had congestive heart failure picture at presentation; more among female sex category and more among patients receiving GPIIbIIIa antagonists. Those bleeding events had been experienced during hospital stay. Conclusion Risk of bleeding can be evaluated using a simple risk score in both STEMI & NSTEMI patients, and across anti-coagulant strategies, providing important prognostic information. Variability in the rates of bleeding is likely based on differences in baseline characteristics, comorbidities, and invasive treatment strategies rather than specific anti-coagulation regimens. Patients at highest risk of bleeding are also at highest risk of ischaemia and thrombotic complications. Thus higher risk patients need a more careful treatment approach to maximize the efficacy of therapy and to reduce thrombotic risk while reducing the bleeding risk.
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Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary Artery Disease in Patients ≥80 Years of Age. J Am Coll Cardiol 2018; 71:2015-2040. [DOI: 10.1016/j.jacc.2017.12.068] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 12/14/2017] [Accepted: 12/19/2017] [Indexed: 02/07/2023]
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Paratz ED, Nicolaides S, Layland J. Many shades of grey: seeking the optimal medical therapy of acute coronary syndrome in older people. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2017. [DOI: 10.1002/jppr.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Jamie Layland
- Peninsula Health Heart Service; Frankston Australia
- Peninsula Clinic School; Monash University; Frankston Australia
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6
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Gimbel ME, Ten Berg JM. Management of elderly patients with a non-ST-segment-elevation acute coronary syndrome. Neth Heart J 2017; 25:409-415. [PMID: 28516369 PMCID: PMC5513990 DOI: 10.1007/s12471-017-1002-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Elderly patients with an acute coronary syndrome are underrepresented in randomised controlled trials. Neither the European Society of Cardiology nor the American Heart Association/American College of Cardiology acute coronary syndrome guidelines provide specific recommendations for elderly patients. However, elderly patients are at higher thrombotic and bleeding risk compared with younger patients leading to difficulties in choosing the optimal treatment. In this review, we discuss the uncertainties we encounter in treating elderly patients with non-ST-elevation acute coronary syndrome and suggest treatment options based on the existing literature.
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Affiliation(s)
- M E Gimbel
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
| | - J M Ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
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7
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Puymirat E, Aissaoui N, Cayla G, Lafont A, Riant E, Mennuni M, Saint-Jean O, Blanchard D, Jourdain P, Elbaz M, Henry P, Bataille V, Drouet E, Mulak G, Schiele F, Ferrières J, Simon T, Danchin N. Changes in One-Year Mortality in Elderly Patients Admitted with Acute Myocardial Infarction in Relation with Early Management. Am J Med 2017; 130:555-563. [PMID: 28065766 DOI: 10.1016/j.amjmed.2016.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2016] [Revised: 12/03/2016] [Accepted: 12/05/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Elderly patients are underrepresented in acute myocardial infarction trials. Our aim was to determine whether, in elderly patients, changes in management in the past 15 years are associated with improved 1-year mortality after hospital admission for myocardial infarction. METHODS We used data from 4 1-month French registries, conducted 5 years apart from 1995 to 2010, including 3389 elderly patients (≥75 years of age). RESULTS From 1995 to 2010, mean age remained stable (82.1 years), similar in ST- and non-ST-elevation myocardial infarction patients. Obesity, diabetes, hypertension, and hypercholesterolemia increased. History of prior myocardial infarction, stroke, and peripheral artery disease remained stable, while history of heart failure decreased. Major changes in management were noted: early percutaneous coronary intervention, early treatment with antiplatelet agents, low-molecular-weight heparin, beta-blockers, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, and statins all increased. Early mortality after hospital admission decreased from 25.0% to 8.4%. One-year mortality decreased from 36.2% to 20.0% (adjusted hazard ratio 2010 vs 1995: 0.47, 0.39-0.57), both for ST-elevation myocardial infarction (36.8% to 21.1%) and non-ST-elevation myocardial infarction (34.8% to 19.1%). Mortality reduction was observed in all age groups, including those ≥85 years of age (from 46.2% to 31.4%). The study period, however, was no longer associated with decreased mortality when variables reflecting management changes were taken into account. CONCLUSIONS Early and 1-year mortality after hospital admission of elderly patients with acute myocardial infarction has substantially decreased over the past 15 years. This improvement is likely mediated by increasing use of recommended management strategies. These data support the application of guidelines derived from trials mostly including younger patients to elderly populations as well.
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Affiliation(s)
- Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France.
| | - Nadia Aissaoui
- AP-HP; HEGP, Department of Critical Care Unit, Paris, France; Université Paris-Descartes, Paris, France
| | - Guillaume Cayla
- Department of Cardiology, CHU Nîmes, Université de Montpellier, France
| | - Alexandre Lafont
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France
| | - Elisabeth Riant
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France
| | - Marco Mennuni
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France; Humanitas Clinical and Research Center, Cardiovascular Department, Rozzano (Milano), Italy
| | - Olivier Saint-Jean
- AP-HP; HEGP, Department of Geriatrics, Paris, France; Université Paris-Descartes, Paris, France
| | | | - Patrick Jourdain
- Department of Cardiology, Centre Hospitalier de Pontoise, France
| | - Meyer Elbaz
- Department of Cardiology, Toulouse University Hospital, France
| | | | - Vincent Bataille
- Department of Cardiology B and Epidemiology, Toulouse University Hospital, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - Elodie Drouet
- AP-HP, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Hôpital Saint Antoine, Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06); INSERM U-698, Paris, France
| | | | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, Besançon, France
| | - Jean Ferrières
- Department of Cardiology B and Epidemiology, Toulouse University Hospital, Toulouse, France; UMR INSERM 1027, Toulouse, France
| | - Tabassome Simon
- AP-HP, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Hôpital Saint Antoine, Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06); INSERM U-698, Paris, France
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Cardiology, Hôpital Européen Georges Pompidou (HEGP), Paris, France; Université Paris-Descartes, Paris, France
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Rocca B, Husted S. Safety of Antithrombotic Agents in Elderly Patients with Acute Coronary Syndromes. Drugs Aging 2016; 33:233-48. [PMID: 26941087 DOI: 10.1007/s40266-016-0359-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
There are unique challenges in the treatment and prevention of acute coronary syndromes (ACS) with antithrombotics in elderly patients: elderly patients usually require multiple drugs due to comorbidities, are highly susceptible to adverse drug reactions and drug-drug interactions, may have cognitive problems affecting compliance and complications, are especially exposed to the risk of falls and, most importantly, ageing is an independent risk factor for bleeding. Antithrombotic drugs, alone or in association, further and variously amplify age-related bleeding risk. Moreover, age-related changes in primary haemostasis may potentially affect the pharmacodynamics of some antiplatelet drugs. Thus, elderly subjects might be more or less sensitive to standard antiplatelet regimens depending on individual characteristics affecting antiplatelet drug response. Importantly, elderly patients are a rapidly growing population worldwide, have the highest incidence of ACS, but are poorly represented in clinical trials. As a consequence, evidence on antithrombotic drug benefits and risks is limited. Thus, in the real-world setting, older people are often denied antithrombotic drugs because of unjustified concerns, or might be over-treated and exposed to excessive bleeding risk. Personalized antithrombotic therapy in elderly patients is particularly critical, to minimize risks without affecting efficacy.
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Affiliation(s)
- Bianca Rocca
- Institute of Pharmacology, Catholic University School of Medicine, Largo F.Vito 1, 00168, Rome, Italy.
| | - Steen Husted
- Medical Department, Hospital Unit West, Herning/Holstebro and Institute of Biomedicine, Aarhus University, Aarhus, Denmark
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9
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Armaganijan LV, Alexander KP, Huang Z, Tricoci P, Held C, Van de Werf F, Armstrong PW, Aylward PE, White HD, Moliterno DJ, Wallentin L, Chen E, Harrington RA, Strony J, Mahaffey KW, Lopes RD. Effect of age on efficacy and safety of vorapaxar in patients with non-ST-segment elevation acute coronary syndrome: Insights from the Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome (TRACER) trial. Am Heart J 2016; 178:176-84. [PMID: 27502866 DOI: 10.1016/j.ahj.2016.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 05/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Antithrombotic therapy plays an important role in the treatment of non-ST-segment elevation acute coronary syndromes (NSTE ACS) but is associated with bleeding risk. Advanced age may modify the relationship between efficacy and safety. METHODS Efficacy and safety of vorapaxar (a protease-activated receptor 1 antagonist) was analyzed across ages as a continuous and a categorical variable in the 12,944 patients with NSTE ACS enrolled in the TRACER trial. To evaluate the effect of age, Cox regression models were developed to estimate hazard ratios (HRs) with the adjustment of other baseline characteristics and randomized treatment for the primary efficacy composite of cardiovascular death, myocardial infarction (MI), stroke, recurrent ischemia with rehospitalization, or urgent coronary revascularization, and the primary safety composite of moderate or severe Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO) bleeding. RESULTS The median age of the population was 64years (25th, 75th percentiles = 58, 71). Also, 1,791 patients (13.8%) were ≤54years of age, 4,968 (38.4%) were between 55 and 64 years, 3,979 (30.7%) were between 65 and 74 years, and 2,206 (17.1%) were 75years or older. Older patients had higher rates of hypertension, renal insufficiency, and previous stroke and worse Killip class. The oldest age group (≥75years) had substantially higher 2-year rates of the composite ischemic end point and moderate or severe GUSTO bleeding compared with the youngest age group (≤54years). The relationships between treatment assignment (vorapaxar vs placebo) and efficacy outcomes did not vary by age. For the primary efficacy end point, the HRs (95% CIs) comparing vorapaxar and placebo in the 4 age groups were as follows: 1.12 (0.88-1.43), 0.88 (0.76-1.02), 0.89 (0.76-1.04), and 0.88 (0.74-1.06), respectively (P value for interaction = .435). Similar to what was observed for efficacy outcomes, we did not observe any interaction between vorapaxar and age on bleeding outcomes. For the composite of moderate or severe bleeding according to the GUSTO classification, the HRs (95% CIs) comparing vorapaxar and placebo in the 4 age groups were 1.73 (0.89-3.34), 1.39 (1.04-1.86), 1.10 (0.85-1.42), and 1.73 (1.29-2.33), respectively (P value for interaction = .574). CONCLUSION Older patients had a greater risk for ischemic and bleeding events; however, the efficacy and safety of vorapaxar in NSTE ACS were not significantly influenced by age.
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Affiliation(s)
| | | | - Zhen Huang
- Duke Clinical Research Institute, Durham, NC
| | | | - Claes Held
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Frans Van de Werf
- Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Philip E Aylward
- South Australian Health and Medical Research Institute, Flinders University and Medical Center, Adelaide, Australia
| | - Harvey D White
- Green Lane Cardiovascular Service, Auckland, New Zealand
| | | | - Lars Wallentin
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Edmond Chen
- Bayer HealthCare Pharmaceuticals Inc, Whippany, NJ
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McCune C, McKavanagh P, Menown IB. A Review of Current Diagnosis, Investigation, and Management of Acute Coronary Syndromes in Elderly Patients. Cardiol Ther 2015; 4:95-116. [PMID: 26396083 PMCID: PMC4675753 DOI: 10.1007/s40119-015-0047-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Indexed: 12/21/2022] Open
Abstract
The elderly constitute a sizeable proportion of the acute coronary syndrome (ACS) population, and this population is continually increasing in number. Guideline-directed therapy is frequently underutilized in the elderly due to concerns about patient safety. However, studies suggest that this subgroup could benefit from many of the conventional and newer therapies available. This paper reviews current literature in the context of contemporary American and European guidance.
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Affiliation(s)
- Claire McCune
- Craigavon Cardiac Centre, Southern Trust, Craigavon, Northern Ireland, BT63 5QQ, UK.
| | - Peter McKavanagh
- Craigavon Cardiac Centre, Southern Trust, Craigavon, Northern Ireland, BT63 5QQ, UK
| | - Ian B Menown
- Craigavon Cardiac Centre, Southern Trust, Craigavon, Northern Ireland, BT63 5QQ, UK
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Andreotti F, Rocca B, Husted S, Ajjan RA, ten Berg J, Cattaneo M, Collet JP, De Caterina R, Fox KAA, Halvorsen S, Huber K, Hylek EM, Lip GYH, Montalescot G, Morais J, Patrono C, Verheugt FWA, Wallentin L, Weiss TW, Storey RF. Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis. Eur Heart J 2015; 36:3238-49. [PMID: 26163482 DOI: 10.1093/eurheartj/ehv304] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 06/12/2015] [Indexed: 12/19/2022] Open
Affiliation(s)
- Felicita Andreotti
- Department of Cardiovascular Science, Catholic University Medical School, Largo F Vito 1, Rome 00168, Italy
| | - Bianca Rocca
- Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - Steen Husted
- Medical Department, Region Hospital West, Herning/Holstebro, Denmark
| | - Ramzi A Ajjan
- Division of Cardiovascular and Diabetes Research, The LIGHT Laboratories, Multidisciplinary Cardiovascular Research Centre, University of Leeds, Leeds, UK
| | - Jurrien ten Berg
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Marco Cattaneo
- Medicina 3, Ospedale San Paolo - Dipartimento di SCienze della Salute, UNiversità degli Studi di Milano, Milan, Italy
| | - Jean-Philippe Collet
- Institut de Cardiologie, INSERM UMRS 1166, Allies in Cardiovascular Trials Initiatives and Organized Networks Group, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France
| | - Raffaele De Caterina
- Department of Cardiology, 'G. d'Annunzio' University - Ospedale SS. Annunziata, Chieti, Italy
| | - Keith A A Fox
- Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Sigrun Halvorsen
- Department of Cardiology B, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kurt Huber
- 3rd Department of Internal Medicine, Cardiology and Emergency Medicine, Wilhelminen Hospital, Montleartstrasse 37, Vienna A-1160, Austria
| | - Elaine M Hylek
- Department of Medicine, Boston University School of Medicine-Boston Medical Center, Boston, MA, USA
| | - Gregory Y H Lip
- University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham B18 7QH, UK
| | - Gilles Montalescot
- Institut de Cardiologie, INSERM UMRS 1166, Pitié-Salpêtrière Hospital (Assistance Publique-Hôpitaux de Paris), Université Pierre et Marie Curie, Paris, France
| | - Joao Morais
- Department of Cardiology, Hospital de Santo André, Leiria, Portugal
| | - Carlo Patrono
- Institute of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | | | - Lars Wallentin
- Uppsala Clinical Research Center and Department of Medical Sciences (Cardiology), Uppsala University, Uppsala, Sweden
| | - Thomas W Weiss
- 3rd Department of Internal Medicine, Cardiology and Emergency Medicine, Wilhelminen Hospital, Montleartstrasse 37, Vienna A-1160, Austria
| | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
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McQuillan BM, Thompson PL. Management of acute coronary syndrome in special subgroups: female, older, diabetic and Indigenous patients. Med J Aust 2014; 201:S91-6. [DOI: 10.5694/mja14.01248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 10/14/2014] [Indexed: 01/08/2023]
Affiliation(s)
- Brendan M McQuillan
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA
- Sir Charles Gairdner Hospital, Perth, WA
| | - Peter L Thompson
- School of Medicine and Pharmacology, University of Western Australia, Perth, WA
- Sir Charles Gairdner Hospital, Perth, WA
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13
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Lopes RD, White JA, Tricoci P, White HD, Armstrong PW, Braunwald E, Giugliano RP, Harrington RA, Lewis BS, Brogan GX, Gibson CM, Califf RM, Newby LK. Age, treatment, and outcomes in high-risk non‐ST-segment elevation acute coronary syndrome patients: Insights from the EARLY ACS trial. Int J Cardiol 2013; 167:2580-7. [DOI: 10.1016/j.ijcard.2012.06.053] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 06/06/2012] [Accepted: 06/16/2012] [Indexed: 10/28/2022]
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Siguret V, Gouin-Thibault I, Gaussem P, Pautas E. Optimizing the Use of Anticoagulants (Heparins and Oral Anticoagulants) in the Elderly. Drugs Aging 2013; 30:687-99. [DOI: 10.1007/s40266-013-0101-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K, Ohman M, Petrie MC, Sonntag F, Sousa Uva M, Storey RF, Wijns W, Zahger D. Guía de práctica clínica de la ESC para el manejo del síndrome coronario agudo en pacientes sin elevación persistente del segmento ST. Rev Esp Cardiol 2012. [DOI: 10.1016/j.recesp.2011.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Malkin CJ, Prakash R, Chew DP. The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry. BMJ Open 2012; 2:e000540. [PMID: 22344538 PMCID: PMC3282292 DOI: 10.1136/bmjopen-2011-000540] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To evaluate the impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes (ACS). DESIGN Retrospective analysis of a national Acute Coronary Syndrome registry (ACACIA). SETTING Multiple Australian (n=39) centres; 25% rural, 52% with onsite cardiac surgery. PATIENTS Unselected consecutive patients admitted with confirmed ACS, total n=2559, median 99 per centre. INTERVENTIONS Management was at the discretion of the treating physician. Analysis of outcome based on age >75 years was compared using Cox proportional hazard with a propensity model to adjust for baseline covariates. MAIN OUTCOME MEASURES Primary outcome was all-cause mortality. Secondary outcomes were bleeding and a composite of any vascular event or unplanned readmission. RESULTS Elderly patients were more likely to present with high-risk features yet were less likely to receive evidence-based medical therapies or receive diagnostic coronary angiography (75% vs 49%, p<0.0001) and early revascularisation (50% vs 30%, p<0.0001). Multivariate analysis found early revascularisation in the elderly cohort to be associated with lower 12-month mortality hazard (0.4 (0.2-0.7)) and composite outcome (0.6 (0.5-0.8)). Propensity model suggested a greater absolute benefit in elderly patients compared to others. CONCLUSIONS Following presentation with ACS, elderly patients are less likely to receive evidence-based medical therapies, to be considered for an early invasive strategy and be revascularised. Increasing age is a significant barrier to physicians when considering early revascularisation. An early invasive strategy with revascularisation when performed was associated with substantial benefit and the absolute accrued benefit appears to be higher in elderly patients.
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Comparison of bleeding complications and one-year survival of low molecular weight heparin versus unfractioned heparin for acute myocardial infarction in elderly patients. The FAST-MI registry. Int J Cardiol 2011; 166:106-10. [PMID: 22078393 DOI: 10.1016/j.ijcard.2011.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 09/12/2011] [Accepted: 10/13/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND There are limited data on the safety and efficacy of low molecular weight heparin (LMWH) in elderly patients with acute myocardial infarction (AMI). METHODS We aimed to compare LMWH with unfractioned heparin (UFH) in the management of AMI in elderly patients. FAST-MI is a nationwide registry carried out over a 1-month period in 2005, including consecutive patients with AMI admitted to intensive care unit <48 h from symptom onset in 223 participating centers. We assessed the impact of LMWH on bleeding, the need for blood transfusion and one-year survival in elderly patients (≥ 75 years). RESULTS 963 patients treated with heparin were included (mean age 82 ± 5 years; 51% women; 42.5% ST-elevation myocardial infarction). Major bleeding (2.4% vs. 6.1%, P=0.004) and blood transfusions (4.6% vs. 9.7%, P=0.002) were significantly less frequent with LMWH compared with the UFH, a difference that persisted after multivariate adjustment (OR=0.41, 95% CI: 0.20-0.83 and OR=0.49, 95% CI: 0.28-0.85, respectively). One-year survival and stroke and reinfarction-free survival were also significantly higher with LMWH compared with UFH (OR=0.66, 95% CI: 0.50-0.85 and OR=0.71, 95% CI: 0.56-0.91, respectively). In two cohorts of patients matched on a propensity score for getting LMWH and with similar baseline characteristics (328 patients per group), major bleeding and transfusion were significantly lower while one-year survival was significantly higher in patients receiving LMWH. CONCLUSIONS The present data show that in elderly patients admitted for AMI, use of LMWH is associated with less bleeding, less need for transfusion, and higher survival, compared with the use of UFH.
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Merino Á, Roldán I, Marín F, Worner F. Prevención de complicaciones hemorrágicas en el síndrome coronario agudo. Med Clin (Barc) 2011; 137:650-5. [DOI: 10.1016/j.medcli.2010.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2010] [Revised: 05/25/2010] [Accepted: 05/27/2010] [Indexed: 11/26/2022]
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Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, Caso P, Dudek D, Gielen S, Huber K, Ohman M, Petrie MC, Sonntag F, Uva MS, Storey RF, Wijns W, Zahger D. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2011; 32:2999-3054. [PMID: 21873419 DOI: 10.1093/eurheartj/ehr236] [Citation(s) in RCA: 2468] [Impact Index Per Article: 189.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Enoxaparin reduces adrenergic contraction of resistance arterioles in aging and in aging associated with diabetes via engagement of MAP kinase pathway. Blood Coagul Fibrinolysis 2011; 22:310-6. [DOI: 10.1097/mbc.0b013e328345123d] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bossaert L, O'Connor RE, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Hoek TLV, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e175-212. [PMID: 20959169 DOI: 10.1016/j.resuscitation.2010.09.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Samama MM. Use of Low-Molecular-Weight Heparins and New Anticoagulants in Elderly Patients with Renal Impairment. Drugs Aging 2011; 28:177-93. [DOI: 10.2165/11586730-000000000-00000] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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O'Connor RE, Bossaert L, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Vanden Hoek TL, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S422-65. [PMID: 20956257 DOI: 10.1161/circulationaha.110.985549] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Antithrombotic Therapy in the Elderly. J Am Coll Cardiol 2010; 56:1683-92. [DOI: 10.1016/j.jacc.2010.04.063] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2010] [Revised: 03/22/2010] [Accepted: 04/05/2010] [Indexed: 11/19/2022]
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Kikkert WJ, Piek JJ, de Winter RJ, Peters RJ, Henriques JPS. Guideline adherence for antithrombotic therapy in acute coronary syndrome: an overview in Dutch hospitals. Neth Heart J 2010; 18:291-9. [PMID: 20657674 PMCID: PMC2881345 DOI: 10.1007/bf03091779] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE To assess current Dutch antithrombotic treatment strategies for acute coronary syndrome (ACS) in light of the current European Society of Cardiology (ESC) guidelines. METHODS For every Dutch hospital with a coronary care unit (CCU) (n = 93) a single cardiologist was interviewed concerning heparin, thienopyridine and GP IIb/IIIa inhibitor (GPI) treatment. In each hospital, we randomly approached one cardiologist assuming equal policy among physicians employed at the same hospital. RESULTS The response rate was 90%. In 59% of hospitals, treatment of ST-elevation myocardial infarction (STEMI) occurred according to the 2008 ESC STEMI guideline, with unfractionated heparin. In contrast, although not recommended, low-molecular-weight heparin (LMWH) was used in 39% (enoxaparin 19%, dalteparin 12%, nadroparin 8%). In non-STEMI, low-molecular-weight-heparins (LMWHs) were used in 97% of all hospitals. Fondaparinux, agent of choice in a noninvasive strategy for the treatment of non-STEMI, was applied in only 2% of hospitals. Although recommended by the ESC, dose adjustment of LMWH therapy for patients with renal failure is not applied in 71% of hospitals. Likewise, LMWH dose adjustment is not applied for patients aged over 75 years in 92% of hospitals. CONCLUSION To a great extent treatment of ACS in the Netherlands occurs according to ESC guidelines. Additional benefit may be achieved by routine dose adjustment of LMWH for patients with renal insufficiency and aged >75 years, since these patients are at high risk of bleeding complications secondary to antithrombotic treatment. Periodical evaluation of real-life practice may improve guideline adherence and potentially improve clinical outcome. (Neth Heart J 2010;18:291-9.).
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Affiliation(s)
- W J Kikkert
- Department of Cardiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Giugliano RP, Braunwald E. The Year in Non–ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2009; 54:1544-55. [DOI: 10.1016/j.jacc.2009.06.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 06/28/2009] [Indexed: 12/19/2022]
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Lopes RD, Alexander KP, Manoukian SV, Bertrand ME, Feit F, White HD, Pollack CV, Hoekstra J, Gersh BJ, Stone GW, Ohman EM. Advanced Age, Antithrombotic Strategy, and Bleeding in Non–ST-Segment Elevation Acute Coronary Syndromes. J Am Coll Cardiol 2009; 53:1021-30. [DOI: 10.1016/j.jacc.2008.12.021] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2008] [Revised: 12/09/2008] [Accepted: 12/16/2008] [Indexed: 10/21/2022]
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Abstract
This article contains a review of the main developments in the field of geriatric cardiology reported during 2008. The focus is on research concerning the specific characteristics of elderly patients with heart failure, arrhythmias, ischemic heart disease, and aortic valve disease.
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