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Mills GB, Ratcovich H, Adams-Hall J, Beska B, Kirkup E, Raharjo DE, Veerasamy M, Wilkinson C, Kunadian V. Is the contemporary care of the older persons with acute coronary syndrome evidence-based? EUROPEAN HEART JOURNAL OPEN 2022; 2:oeab044. [PMID: 35919658 PMCID: PMC9242048 DOI: 10.1093/ehjopen/oeab044] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 11/17/2021] [Accepted: 12/14/2021] [Indexed: 12/13/2022]
Abstract
Globally, ischaemic heart disease is the leading cause of death, with a higher mortality burden amongst older adults. Although advancing age is associated with a higher risk of adverse outcomes following acute coronary syndrome (ACS), older patients are less likely to receive evidence-based medications and coronary angiography. Guideline recommendations for managing ACS are often based on studies that exclude older patients, and more contemporary trials have been underpowered and produced inconsistent findings. There is also limited evidence for how frailty and comorbidity should influence management decisions. This review focuses on the current evidence base for the medical and percutaneous management of ACS in older patients and highlights the distinct need to enrol older patients with ACS into well-powered, large-scale randomized trials.
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Affiliation(s)
- Greg B Mills
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
| | - Hanna Ratcovich
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- University of Copenhagen, Copenhagen, Denmark
| | - Jennifer Adams-Hall
- Cardiothoracic Centre, Royal Victoria Infirmary/Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Benjamin Beska
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Royal Victoria Infirmary/Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Emma Kirkup
- Cardiothoracic Centre, Royal Victoria Infirmary/Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Daniell E Raharjo
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Murugapathy Veerasamy
- Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust and Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Chris Wilkinson
- Cardiothoracic Centre, Royal Victoria Infirmary/Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK
- Cardiothoracic Centre, Royal Victoria Infirmary/Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
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Hudec S, Hutyra M, Precek J, Latal J, Nykl R, Spacek M, Sluka M, Sanak D, Tudos Z, Navratil K, Pavlu L, Taborsky M. Acute myocardial infarction, intraventricular thrombus and risk of systemic embolism. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2020; 164:34-42. [DOI: 10.5507/bp.2020.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 01/03/2020] [Indexed: 01/02/2023] Open
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Lu Y, Zhang H, Wang Y, Zhou T, Welsh J, Liu J, Guan W, Li J, Li X, Zheng X, Spertus JA, Masoudi FA, Krumholz HM, Jiang L. Percutaneous Coronary Intervention in Patients Without Acute Myocardial Infarction in China: Results From the China PEACE Prospective Study of Percutaneous Coronary Intervention. JAMA Netw Open 2018; 1:e185446. [PMID: 30646292 PMCID: PMC6324328 DOI: 10.1001/jamanetworkopen.2018.5446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE Despite a rapid increase in percutaneous coronary intervention (PCI) procedures in China, little is known about patient-reported health status before and after PCI in patients without acute myocardial infarction (AMI). OBJECTIVE To describe self-perceived angina-specific health status prior to PCI and 1 year after the procedure in patients without AMI in China. DESIGN, SETTING, AND PARTICIPANTS The China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Prospective Study of PCI was a population-based, multicenter cohort study of a consecutive sample of 1611 patients without AMI undergoing elective PCI. Participants were enrolled from 40 hospitals in 18 provinces in China from December 2012 to August 2014. Participants were eligible if they underwent PCI for stable and unstable angina and did not have AMI. Participants were excluded if they died in hospital, withdrew from follow-up, or had missing data on self-reported health status at baseline or at 1 year after PCI. The date of the analysis was September 15, 2018. EXPOSURES Percutaneous coronary intervention for ischemic heart disease. MAIN OUTCOMES AND MEASURES Angina frequency and angina-related quality of life were assessed with the Seattle Angina Questionnaire (SAQ) immediately prior to PCI and 1 year after the procedure. Either (1) an increase in the SAQ Angina Frequency score of 10 or more points or (2) an increase in the SAQ Quality-of-Life score of 10 or more points was considered to represent clinically significant improvement. RESULTS Of 1611 patients, 520 (32.3%) were women; mean (SD) age was 61.3 (9.8) years. Among these patients, 443 (27.5%) had stable coronary artery disease and 1168 (72.5%) had unstable angina. One hundred fourteen of 443 patients undergoing PCI for stable coronary artery disease (25.7%) and 175 of 1168 undergoing PCI for unstable angina (15.0%) had no reported angina symptoms at the time of the procedure (SAQ Angina Frequency score = 100). Moreover, 18% of all patients (290) had minimal angina symptoms (SAQ Angina Frequency score >90) and, thus, no potential for substantial clinical improvement. Patients with smaller clinical improvements in angina symptom burden at 1 year following PCI had significantly higher baseline SAQ scores for all scales than patients with greater clinical improvement, but generally similar sociodemographic and procedural characteristics. CONCLUSIONS AND RELEVANCE In this study, 25.7% of patients undergoing PCI for stable coronary artery disease had no reported angina symptoms at the time of the procedure. Patients with smaller clinical improvements in angina symptom burden had higher baseline SAQ scores, which highlights the importance of ascertaining impairment from angina among patients without AMI prior to performing PCI.
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Affiliation(s)
- Yuan Lu
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Haibo Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Tianna Zhou
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut
| | - John Welsh
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut
| | - Jiamin Liu
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - Wenchi Guan
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
| | - John A. Spertus
- Health Outcomes Research, Saint Luke’s Mid America Heart Institute/University of Missouri-Kansas City, Kansas City
| | | | - Harlan M. Krumholz
- Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Lixin Jiang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
- NHC Key Laboratory of Clinical Research for Cardiovascular Medications, Beijing, People’s Republic of China
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de Boer MJ, Ottervanger JP, Suryapranata H, Hoorntje JCA, Dambrink JHE, Gosselink ATM, van't Hof AWJ, Zijlstra F. Old age and outcome after primary angioplasty for acute myocardial infarction. J Am Geriatr Soc 2010; 58:867-72. [PMID: 20406318 DOI: 10.1111/j.1532-5415.2010.02821.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To assess the influence of age as an independent factor determining the prognosis and outcome of patients with acute myocardial infarction (AMI) treated using primary percutaneous coronary intervention (PCI). DESIGN A retrospective analysis from a dedicated database. SETTING A high-volume interventional cardiology center in the Netherlands. PARTICIPANTS Four thousand nine hundred thirty-three consecutive patients with AMI. MEASUREMENTS Baseline characteristics and clinical outcomes after 30 days and 1 year were compared according to age categorized in three groups: younger than 65, 65 to 74, and 75 and older. A more-detailed analysis was performed with six age groups, from younger than 40 to 80 and older. RESULTS Of the 4,933 consecutive patients with AMI treated with PCI between 1992 and 2004, 643 were aged 75 and older. Multivariate analysis revealed that patients aged 65 to 75 had a greater risk of 1-year mortality than those younger than 65 (adjusted odds ratio (AOR)=1.57, 95% confidence interval (CI)=1.15-2.16) and that those aged 75 and older had a greater risk of 1-year mortality than those younger than 65 (AOR=3.03, 95% CI=2.14-4.29). CONCLUSION In this retrospective analysis, older age was independently associated with greater mortality after PCI for AMI. Patients aged 65 and older had a higher risk of mortality than younger patients, and those aged 75 and older had the highest risk of mortality.
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Affiliation(s)
- Menko-Jan de Boer
- Department of Cardiology, Isala Klinieken, Locatie Weezenlanden, Zwolle, the Netherlands.
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Combined therapy with Chinese medicine and percutaneous transradial coronary intervention for a centenarian patient with acute myocardial infarction. Chin J Integr Med 2009; 15:233-5. [PMID: 19568719 DOI: 10.1007/s11655-009-0233-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2009] [Indexed: 10/20/2022]
Abstract
There are not enough clinical data about centenarians with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). A 104-year-old woman exhibited sharp chest pain and severe dyspnea. In routine examinations, her electrocardiogram showed 1-3 mm ST-segment elevation from V1 to V4 leads, the cardiac enzymes were also elevated: creatine kinase (CK)-MB was 45.7 U/L, and cardiac specific troponin I was 40 microg/L. A two-dimensional echocardiography showed anteroseptal akinesia with severely depressed left ventricular function, 38% ejection fraction. She primarily refused to receive percutaneous coronary intervention (PCI) considering her old age, and she was given a dual anti-platelet medications (low molecular heparin and frusemide). Three days later, due to continuously deteriorating angina pectoris and dyspnea, she was treated with PCI. A diagnostic percutaneous transradial coronary angiography revealed 95% stenosis in the proximal left anterior descending artery (LAD) with 90% stenosis at the origin of diagonal one. A percutaneous coronary intervention for the LAD lesion was successfully performed, and the final angiogram showed a good coronary flow without residual stenosis. The dual anti-platelet medications had to be ceased due to the upper gastrointestinal bleeding after one week and Tongguan Capsule (Chinese medicine composed with Radix Astragali, Radix Salviae Miltiorrhiae, etc.) was administered continuously. The six-month follow-up displayed a high level quality of life for the centenarian woman with the absence of angina pectoris and dyspnea. The case reinforces the importance of PCI for very elderly patients with AMI even centenarian people and reveals the possibility that Tongguan Capsule can be used to replace dual anti-platelet medication with the reduction of bleeding complications.
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