Immediate and long-term results of coronary angioplasty in patients aged 80 years and older

RID serve as a more appropriate measure than phenol sulfuric acid method for natural water-soluble polysaccharides quantification

With structural diversity of water-soluble polysaccharides, their precise quantitative analysis by phenol‑sulfuric acid method becomes more difficult and challenging. In this study, the quantification analysis of dextran and glucose in phenol sulfuric acid method was compared in this paper. When the concentration is below 90 μg/mL, the quantification of glucose is close to theoretical value, however, glucose derivatives have significantly different absorption. Later, quantitative factors of water-soluble polysaccharide in RID measurement were investigated. The optimum temperature was 40 °C and linear range was 0.3125-10.0 mg/mL in RID for dextrans (1.0-500 kDa) and glucose derivatives. Method validation studies of the RID method were further performed and compared to conventional phenol sulfuric acid method, which demonstrated that RID measurement is more reliable and satisfactory method. The intervention of water-soluble impurity in RID response should be well control below 6% (w/w). By comparison, the RID measurement could well alleviate drawbacks in phenol‑sulfuric acid method.

A simple score for the prediction of stent thrombosis in patients with ST elevation myocardial infarction: TIMI risk index

Introduction: The present study aimed to evaluate the potential utility of thrombosis in myocardial infarction (TIMI) risk index (TRI) for the prediction of stent thrombosis (ST) in ST elevation myocardial infarction (STEMI) patients who were treated with primary percutaneous coronary intervention ( pPCI ). Methods: This retrospective study was related to the clinical data of 1275 consecutive STEMI patients who underwent pPCI from January 2013 to January 2018. The TRI was calculated for each patient, and the following equation was used; TRI = heart rate x [age/10]2/systolic blood pressure. For the definition of ST, the criteria as proposed by the Academic Research Consortium were applied. Results: The incidence of ST was 3.2% (n=42 patients) in the study. The median value of the TRI was significantly elevated in patients with ST compared to those without ST (22 [17-32] vs. 16 [11-21], P<0.001, respectively). In a multivariate logistic regression analysis, the TRI was an independent predictor of ST (odds ratio [OR]: 1.061; 95% CI: 1.038-1.085; P<0.001). In a receiver operating characteristic curve analysis, the optimal value of the TRI for the prediction of ST was 25.8 with a sensitivity of 45.2% and a specificity of 86.4%. Conclusion: The present study finding has demonstrated that the TRI may be an independent predictor of ST in STEMI patients who were treated with pPCI . To the best of our knowledge, this is the first study in the literature in which the TRI and its relationship with ST was evaluated in STEMI patients treated with pPCI .

The impact of age on the implementation of evidence-based medications in patients with coronary artery disease and its prognostic significance: a retrospective cohort study

Background

Elderly patients with coronary artery disease (CAD) frequently complicated with more cardiovascular risk factors, but received fewer evidence-based medications (EBMs). This study explored the association of EBMs compliance in different age groups and the risk of long-term death.

Methods

A retrospective analysis was conducted from a single registered database. 2830 consecutive patients with CAD were enrolled and grouped into 3 categories by age. The primary end point was all-cause mortality and secondary endpoint is cardiovascular mortality.

Results

The mean follow-up time was 30.25 ± 11.89 months and death occurred in 270 cases,including 150 cases of cardiac death. Cumulative survival curves indicated that the incidence rates of all-cause death and cardiovascular death increased with age (older than 75 years old vs. 60 to 75 years old vs. younger than 60 years old, mortality: 18.7% vs. 9.6% vs. 4.1%, p < 0.001; cardiovascular mortality: 10.3% vs. 5.1% vs. 2.7%, p < 0.001). The percentage of elderly patients using no EBMs was significantly higher than the percentages in the other age group (7.7% vs. 4.6% vs. 2.2%,p < 0.05). Cox regression analysis revealed the benefit of combination EBMs (all-cause mortality: hazard ratio [HR] 0.15, 95% CI 0.08–0.27; cardiac mortality: HR 0.08, 95% CI 0.04–0.19) for older CAD patients. Similar trends were found about different kinds of EBMs in elderly patients.

Conclusions

Elderly patients with CAD had higher risk of death but a lower degree of compliance with EBMs usage. Elderly CAD patients could receive more clinical benefits by using EBMs.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5049-x) contains supplementary material, which is available to authorized users.

Are the elderly different? Factors influencing mortality after percutaneous coronary intervention with stent implantation

BACKGROUND

The aim of this study was to investigate factors influencing mortality after percutaneous coronary intervention (PCI) in patients aged ≥ 75 years compared to younger patients.

PATIENTS AND METHODS

A total of 1,809 coronary heart disease (CHD) patients after PCI with stent implantation in our hospital were assessed. Kaplan-Meier analyses with log-rank test and Cox regression analyses were performed on three predefined models concerning primary endpoint of all-cause mortality. Model 1 was a univariate analysis of the influence of age dichotomized by age 75 years on the primary endpoint. Model 2 included age and classical cardiovascular risk factors (CVRFs, e.g., body mass index (BMI), smoking, diabetes, and hypertension). Model 3 consisted of age, classical CVRFs, and additional factors (e.g., medication; hemoglobin, peripheral arterial disease (PAD), low-density lipoprotein cholesterol (LDL-C) and creatinine levels, and left ventricular ejection fraction (LVEF)).

RESULTS

In the mean follow-up of 137 ± 61 weeks 375 patients died. Age ≥ 75 years was significantly related to mortality in all models. In model 3, previous stroke, PAD, diabetes, elevated levels of serum creatinine, and increased LDL-C were related to elevated mortality, higher hemoglobin levels, and LVEF > 50% were associated with decreased mortality in all patients and in patients < 75 years. In patients ≥ 75 years arterial hypertension was associated with poor outcome (hazard ratio (HR) 7.989, p = 0.040), previous antiplatelet therapy showed reduced mortality (HR 0.098, p = 0.039).

CONCLUSION

Although risk factors such as previous stroke, PAD, diabetes, renal insufficiency, and anemia were predictors for death in all patients and patients < 75 years, in the elderly only arterial hypertension increased, whereas treatment with platelet inhibitors decreased mortality.