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Effect of Age on Procedural Success, Complications, and Clinical Outcome From a Large Angioplasty Registry. Crit Pathw Cardiol 2019; 18:23-31. [PMID: 30747762 DOI: 10.1097/hpc.0000000000000158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Increasing age appears to be a risk factor for adverse outcome in patients undergoing percutaneous coronary intervention (PCI). The goal of this study was to compare procedural success, complications, and 12 months major adverse cardiac events (MACE) based on age using a large angioplasty registry. METHODS This registry included 10,412 patients with at least 12-month follow-up from April 1993 to April 2011. Patients were divided into 3 age groups: group 1 age < 60 (n = 6195), group 2 age 60-75 (n = 3724) and group 3 elderly age ≥ 75 (n = 493). RESULTS Procedural success rate was not significantly different across the 3 age groups. (96.9% in group 1, 97.1% in group 2, and 96.1% in elderly group, P = 0.759). Procedural complications occurred in 179 (2.9%) of group 1, 98 (2.6%) of group 2 and 15 (3.0%) of elderly group (P = 0.678). In-hospital complications increased with increasing age (311 [5.0%] in group 1, 235 [6.3%] in group 2, and 46 [9.3%] in elderly group; P < 0.001). Twelve-month MACE also increased with increasing age (235 [4.1%] in group 1, 169 [4.9%] in group 2 and 26 [5.7%] in elderly group; P = 0.021). Multivariate analysis showed that age was not a predictor for unsuccessful PCI, procedural complications, or 12-month MACE. However, increasing age was independent predictors of in-hospital complications and death. CONCLUSION Despite increased in-hospital complications with increasing age, procedural success, and complications were not higher in elderly. Our data suggest that PCI should not be denied in elderly if indicated with procedural safety similar to other age groups.
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Hejazi SF, Iranirad L, Doostali K, Khodadadi N, Norouzi S. In-Hospital Clinical Outcomes and Procedural Complications of Percutaneous Coronary Intervention in Elderly Patients. Cardiol Res 2017; 8:199-205. [PMID: 29118881 PMCID: PMC5667706 DOI: 10.14740/cr582e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 08/08/2017] [Indexed: 12/02/2022] Open
Abstract
Background As population growth leads to an increase in the number of the elderly with coronary artery disease, an evaluation of the clinical outcomes of percutaneous coronary intervention (PCI) in the elderly patients seems to be essential. Methods A prospective, observational cohort study was performed on 468 patients in two groups of elderly and non-elderly patients (mean age: 60.01 ± 10.84 years; ≥ 70 years, 20.1%; men, 62%) who underwent PCI, to evaluate the procedural success and in-hospital major and minor adverse cardiovascular events in the elderly patients. Results The procedural success rate was significantly lower (95.7% vs. 99.5%, P = 0.017) and the rates of in-hospital complications were significantly higher (10.6% vs. 0.8%, P < 0.0001) in elderly (+70) than in non-elderly patients. On the basis of a multivariate analysis, being elderly was not an independent predictor of procedural failure, but increased the chance of in-hospital complications to 8% higher (odds ratio: 0.08; 95% confidence interval: 0.01 - 0.39; P = 0.002). Conclusion Regardless of the difference in the procedural success and in-hospital complication rates between our two study groups, aging is not an important predictor of them. Furthermore, PCI should not be refused in elderly patients if indicated.
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Affiliation(s)
- Seyed Fakhreddin Hejazi
- Department of Cardiology, Shahid Beheshti, Qom University of Medical Science and Health Services, Qom, Iran
| | - Leili Iranirad
- Department of Cardiology, Shahid Beheshti, Qom University of Medical Science and Health Services, Qom, Iran
| | - Kobra Doostali
- Department of Cardiology, Shahid Beheshti, Qom University of Medical Science and Health Services, Qom, Iran
| | - Narges Khodadadi
- Department of Medicine, Shahid Beheshti, Qom University of Medical Science and Health Services, Qom, Iran
| | - Sameeye Norouzi
- Department of Cardiology, Shahid Beheshti, Qom University of Medical Science and Health Services, Qom, Iran
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Garland M, Hsu FC, Shen P, Clark CJ. Optimal Modified Frailty Index Cutoff in Older Gastrointestinal Cancer Patients. Am Surg 2017. [DOI: 10.1177/000313481708300837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The newly characterized modified frailty index (mFI) is a robust predictor of postoperative outcomes for surgical patients. The present study investigates the optimal cutoff for mFI specifically in older gastrointestinal (GI) cancer patients undergoing surgery. All patients more than 60 years old who underwent surgery for a GI malignancy (esophagus, stomach, colon, rectum, pancreas, liver, and bile duct) were identified in the 2005 to 2012 National Surgical Quality Improvement Program, Participant Use Data File (NSQIP PUF). Patients undergoing emergency procedures, of American Society of Anesthesiologists (ASA) five status, or diagnosed with preoperative sepsis were excluded. Logistic regression modeling and 10-fold cross validation were used to identify an optimal mFI cutoff. A total of 41,455 patients (mean age 72, 47.4% female) met the eligibility criteria. Among them, 19.0 per cent (n = 7891) developed a major postoperative complication and 2.8 per cent (n = 1150) died within 30 days. A random sampling by a cancer site was performed to create 90 per cent training and 10 per cent test sample datasets. Using 10-fold cross validation, logistical regression models evaluated the association between mFI and endpoints of 30-day mortality and major morbidity at various cutoffs. Optimal cutoffs for 30-day mortality and major morbidity were mFI ≥ 0.1 and ≥0.2, respectively. After adjusting for age, sex, ASA, albumin ≥3g/dl, and body mass index ≥ 30 kg/m2, mFI ≥ 0.1 was associated with increased mortality (odds ratio (OR) 1.49, 1.30–1.71 95% confidence interval (CI), P < 0.001) and mFI ≥ 0.2 was associated with increased morbidity (OR 1.52, 1.39–1.65 95% CI, P < 0.001). For older GI cancer patients, a very low mFI was a predictor of poor postoperative outcomes with an optimal cutoff of two or more mFI characteristics.
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Affiliation(s)
| | | | - Perry Shen
- Biostatistical Sciences, Division of Public Health Sciences, and
| | - Clancy J. Clark
- Biostatistical Sciences, Division of Public Health Sciences, and
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Comparison of 30-Day and Long-Term Outcomes and Hospital Complications Among Patients Aged <75 Versus ≥75 Years With ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention. Am J Cardiol 2017; 119:1897-1901. [PMID: 28460740 DOI: 10.1016/j.amjcard.2017.03.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/16/2017] [Accepted: 03/16/2017] [Indexed: 01/09/2023]
Abstract
Our aim was to evaluate the mortality rate and occurrence of complications in patients aged <75 versus ≥75 years with ST-elevation myocardial infarction (STEMI). We studied 1,657 consecutive patients with STEMI hospitalized in the cardiac intensive care unit during 2008 to 2014. All patients underwent primary percutaneous intervention, of which 292 (18%) were aged ≥75 years. Patient records were evaluated for in-hospital complications, 30-day mortality, and long-term mortality over a mean period of 3.4 ± 2.1 years. Compared with younger patients, patients aged ≥75 years had a significantly higher rate of coronary disease risk factors, prolonged symptom duration (512 ± 640 vs 333 ± 545 minutes, p <0.01) and door-to-balloon time (51.1 ± 24 vs 45.6 ± 38, p = 0.02). Patients aged ≥75 years had more in-hospital noncardiac and cardiac complications, including cardiogenic shock and arrhythmia, and had higher 30-day and long-term mortalities. Cardiogenic shock was associated with increased short- and long-term mortality in the older group but was not incremental over the noncardiogenic shock cohort. In conclusion, in patients aged ≥75 years who underwent primary percutaneous intervention for STEMI, the short- and long-term mortality rate was greater than fourfold higher compared with younger patients.
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Mogal H, Vermilion SA, Dodson R, Hsu FC, Howerton R, Shen P, Clark CJ. Modified Frailty Index Predicts Morbidity and Mortality After Pancreaticoduodenectomy. Ann Surg Oncol 2017; 24:1714-1721. [PMID: 28058551 DOI: 10.1245/s10434-016-5715-0] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pancreatic cancer is a disease of older adults, who may present with limited physiologic reserve. The authors hypothesized that a frailty index can predict postoperative outcomes after pancreaticoduodenectomy (PD). METHODS All patients who underwent PD were identified in the 2005-2012 NSQIP Participant Use File. Patients undergoing emergency procedures, those with an American Society of Anesthesiologists (ASA) classification of five, and those with a diagnosis of preoperative sepsis were excluded from the study. A modified frailty index (mFI) was defined by 11 variables within the National Surgical Quality Improvement Program (NSQIP) previously used for the Canadian Study of Health and Aging-Frailty Index. An mFI score of 0.27 or higher was defined as a high mFI. Uni- and multivariate analyses were performed to evaluate postoperative outcomes. RESULTS This study enrolled 9986 patients (age 65 ± 12 years, 48.8% female) who underwent PD. Of these patients, 6.4% (n = 637) had a high mFI (>0.27). Increasing mFI was associated with higher prevalence of postoperative morbidity (p < 0.001) and 30-days mortality (p < 0.001). In the univariate analysis, high mFI was associated with increased morbidity (odds ratio [OR] 1.68; 95% confidence interval [CI] 1.43-1.97; p < 0.001) and 30-days mortality (OR 2.45; 95% CI 1.74-3.45; p < 0.001). After adjustment for age, sex, ASA classification, albumin level, and body mass index (BMI), high mFI remained an independent preoperative predictor of postoperative morbidity (OR 1.544; 95% CI 1.289-1.850; p < 0.0001) and 30-days mortality (OR 1.536; 95% CI 1.049-2.248; p = 0.027). CONCLUSIONS High mFI is associated with postoperative morbidity and mortality after PD and can aid in preoperative risk stratification.
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Affiliation(s)
- Harveshp Mogal
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Sarah A Vermilion
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Rebecca Dodson
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Fang-Chi Hsu
- Department of Biostatistical Sciences, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Russell Howerton
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Perry Shen
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA
| | - Clancy J Clark
- Division of Surgical Oncology, Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC, USA. .,Division of Surgical Oncology, Department of Surgery, Medical Center Boulevard, Winston-Salem, NC, USA.
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Nammas W, de Belder A, Niemelä M, Sia J, Romppanen H, Laine M, Karjalainen PP. Long-term clinical outcome of elderly patients with acute coronary syndrome treated with early percutaneous coronary intervention: Insights from the BASE ACS randomized controlled trial: Bioactive versus everolimus-eluting stents in elderly patients. Eur J Intern Med 2017; 37:43-48. [PMID: 27499178 DOI: 10.1016/j.ejim.2016.07.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/28/2016] [Accepted: 07/24/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The BASE ACS trial demonstrated an outcome of titanium-nitride-oxide-coated bioactive stents (BAS) that was non-inferior to everolimus-eluting stents (EES) in patients presenting with acute coronary syndrome (ACS). We performed a post hoc analysis of elderly versus non-elderly patients from the BASE ACS trial. METHODS We randomized 827 patients (1:1) presenting with ACS to receive either BAS or EES. The primary endpoint was major adverse cardiac events (MACE): a composite of cardiac death, non-fatal myocardial infarction (MI), or ischemia-driven target lesion revascularization (TLR). Follow-up was planned at 12months and yearly thereafter for up to 7years. Elderly age was defined as ≥65years. RESULTS Of the 827 patients enrolled in the BASE ACS trial, 360 (43.5%) were elderly. Mean follow-up duration was 4.2±1.9years. MACE was more frequent in elderly versus younger patients (19.7% versus 12.0%, respectively, p=0.002), probably driven by more frequent cardiac death and non-fatal MI events (5.3% versus 1.5%, and 9.7% versus 4.5%, p=0.002 and p=0.003, respectively). The rates of ischemia-driven TLR were comparable (p>0.05). In propensity score-matched analysis (215 pairs), only cardiac death was more frequent in elderly patients (6% versus 1.4%, respectively, p=0.01). Diabetes independently predicted both MACE and cardiac death in elderly patients. CONCLUSIONS Elderly patients treated with stent implantation for ACS had worse long-term clinical outcome, compared with younger ones, mainly due to a higher death rate.
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Affiliation(s)
- Wail Nammas
- Heart Center, Satakunta Central Hospital, Pori, Finland
| | - Adam de Belder
- Department of Cardiology, Brighton and Sussex University Hospital NHS Trust, Brighton, UK
| | - Matti Niemelä
- Department of Internal Medicine, Division of Cardiology, University of Oulu, Oulu, Finland
| | - Jussi Sia
- Department of Cardiology, Kokkola Central Hospital, Kokkola, Finland
| | - Hannu Romppanen
- Department of Internal Medicine, Division of Cardiology, University of Oulu, Oulu, Finland; Heart Centre, Kuopio University Hospital, Kuopio, Finland
| | - Mika Laine
- Helsinki University Hospital, Helsinki, Finland
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Chen Q, Yang Y, Liu Y, Ke D, Wu Q, Li G. Safety and effectiveness of percutaneous coronary intervention (PCI) in elderly patients. A 5-year consecutive study of 201 cases with PCI. Arch Gerontol Geriatr 2010; 51:312-6. [DOI: 10.1016/j.archger.2010.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 01/08/2010] [Accepted: 01/15/2010] [Indexed: 10/19/2022]
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Eckart RE, Shry EA, Simpson DE, Stajduhar KC. Percutaneous Coronary Intervention in the Elderly: Procedural Success and 1‐Year Outcomes. ACTA ACUST UNITED AC 2007; 12:366-8. [PMID: 14610387 DOI: 10.1111/j.1076-7460.2003.02505.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Clinical trials have found increased morbidity in elderly persons presenting for percutaneous coronary intervention for chronic stable angina. Long-term follow-up is limited for the elderly following percutaneous coronary intervention. The authors reviewed all coronary interventions performed from January 1998 to August 2001. One year following the procedure, subjects were screened for death, need for revascularization, and myocardial infarction. There were 401 subjects aged >/=65 years (mean 73.4+/-6.0 years) and 479 subjects aged <65 years (mean 55.6+/-6.7 years). Although there was no difference in 1-year rate of subsequent myocardial infarction or in revascularization, the elderly were more likely to die during hospitalization (4.7% vs. 1.0%, p<0.01), and at 1 year (10.2% vs. 4.0%, p<0.01). When controlled for ejection fraction, age was no longer significant in either predischarge mortality or in 1-year mortality. Excess postpercutaneous coronary intervention mortality in the elderly may be due to underlying comorbidities and not due to subsequent myocardial infarction or revascularization.
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Primary percutaneous coronary intervention in elderly patients with ST-elevation acute myocardial infarction. Chin Med J (Engl) 2006. [DOI: 10.1097/00029330-200607020-00001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Schuurmans H, Steverink N, Lindenberg S, Frieswijk N, Slaets JPJ. Old or frail: what tells us more? J Gerontol A Biol Sci Med Sci 2004; 59:M962-5. [PMID: 15472162 DOI: 10.1093/gerona/59.9.m962] [Citation(s) in RCA: 338] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Selecting elderly persons who need geriatric interventions and making accurate treatment decisions are recurring challenges in geriatrics. Chronological age, although often used, does not seem to be the best selection criterion. Instead, the concept of frailty, which indicates several concurrent losses in resources, can be used. METHODS The predictive values of chronological age and frailty were investigated in a large community sample of persons aged 65 years and older, randomly drawn from the register of six municipalities in the northern regions of the Netherlands (45% of the original addressees). The participants' generative capacity to sustain well-being (i.e., self-management abilities) was used as the main outcome measure. RESULTS When using chronological age instead of frailty, both too many and too few persons were selected. Furthermore, frailty related more strongly (with beta values ranging from -.25 to -.39) to a decline in the participants' self-management abilities than did chronological age (with beta values ranging from -.06 to -.14). Chronological age added very little to the explained variances of all outcomes once frailty was included. CONCLUSIONS Using frailty as the criterion to select older persons at risk for interventions may be better than selecting persons based only on their chronological age.
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Affiliation(s)
- Hanneke Schuurmans
- University Hospital Groningen, Department of Internal Medicine, PO Box 30 001, 9700 RB, the Netherlands.
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