ISSN 1671-5411 CN 11-5329/R
Volume 17 Issue 8
Sep.  2020
Turn off MathJax
Article Contents
Fernando F. Gonçalves, José P. Guimarães, Sara C. Borges, Pedro S. Mateus, José I. Moreira. Impact of coronary angioplasty in elderly patients with non-ST-segment elevation myocardial infarction. J Geriatr Cardiol 2020; 17(8): 449-454. doi: 10.11909/j.issn.1671-5411.2020.08.001
Citation: Fernando F. Gonçalves, José P. Guimarães, Sara C. Borges, Pedro S. Mateus, José I. Moreira. Impact of coronary angioplasty in elderly patients with non-ST-segment elevation myocardial infarction. J Geriatr Cardiol 2020; 17(8): 449-454. doi: 10.11909/j.issn.1671-5411.2020.08.001

Impact of coronary angioplasty in elderly patients with non-ST-segment elevation myocardial infarction

doi: 10.11909/j.issn.1671-5411.2020.08.001
More Information
  • Corresponding author: Fernando F. Gonçalves, Cardiology Department, Cen tro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal. E-mail: fernando.fonseca.goncalves@gmail.com
  • Received Date: 2020-06-16
  • Accepted Date: 2020-08-14
  • Rev Recd Date: 2020-07-28
  • Available Online: 2020-08-28
  • Publish Date: 2020-09-07
  •  Background As treatment of coronary artery disease improved over the last years, management of elder patients remained a matter of debate since this age group has been underrepresented in most trials. The study aimed to evaluate a population of patients with ≥ 85 years old with non-ST-segment elevation myocardial infarction (NSTEMI) and compare the prognosis according to coronary revascularization execution. Methods We retrospectively studied 324 patients included in a national multicenter registry between October 2010 and October 2018, who underwent coronary angiography and had at least one stenosis ≥ 50%. Results In this population, 73.1% of the patients underwent percutaneous coronary intervention (PCI) and 26.9% of the patients underwent optimized medical treatment (OMT). The OMT group had more past history of diabetes, stroke and dementia. On coronary angiography, the PCI group used more often the femoral artery access and single-vessel lesions were also more common. Three-vessel disease was more common in the OMT group. During hospitalization, there were more major bleeding events and death in the PCI group. During the one-year follow-up, there were no significant differences in all-cause mortality rate. Conclusions Very old patients with NSTEMI submitted to OMT had more comorbidities and more three-vessel disease, factors that could have influenced the therapeutic decision. Patients undergoing PCI had more in-hospital major bleeding events and mortality, with no significant differences after one year.
  • loading
  • [1]
    Lopes RD, Gharacholou SM, Holmes DN, et al. Cumulative incidence of death and rehospitalization among the elderly in the first year after NSTEMI. Am J Med 2015; 128: 582-590. doi: 10.1016/j.amjmed.2014.12.032
    [2]
    Avezum A, Makdisse M, Spencer F, et al. Impact of age on management and outcome of acute coronary syndrome: obser vations from the Global Registry Of Acute Coronary Events (GRACE). Am Heart J 2005; 149: 67-73. doi: 10.1016/j.ahj.2004.06.003
    [3]
    Kumar S, McDaniel M, Samady H, et al. Contemporary revascularization dilemmas in older adults. J Am Heart Assoc 2020; 9: e014477.
    [4]
    Thygesen K, Alpert JS, Jaffe AS, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J 2019; 40: 237-269. doi: 10.1093/eurheartj/ehy462
    [5]
    Alexander KP, Newby LK, Armstrong PW, et al. Acute coronary care in the elderly, part Ⅱ: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 2007; 115: 2570-2589. doi: 10.1161/CIRCULATIONAHA.107.182616
    [6]
    Devlin G, Gore JM, Elliott J, et al. Management and 6-month outcomes in elderly and very elderly patients with high-risk non-ST-elevation acute coronary syndromes: the Global Registry of Acute Coronary Events. Eur Heart J 2008; 29: 1275-1282.
    [7]
    Bach RG, Cannon CP, Weintraub WS, et al. The effect of rou tine, early invasive management on outcome for elderly pa tients with non-ST-segment elevation acute coronary syndro mes. Ann Intern Med 2004; 141: 186-195. doi: 10.7326/0003-4819-141-3-200408030-00007
    [8]
    Bauer T, Koeth O, Jünger C, et al. Effect of an invasive stra tegy on in-hospital outcome in elderly patients with non- ST-elevation myocardial infarction. Eur Heart J 2007; 28: 2873-2878. doi: 10.1093/eurheartj/ehm464
    [9]
    Savonitto S, Cavallini C, Petronio AS, et al. Early aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndrome: a randomized controlled trial. JACC Cardiovasc Interv 2012; 5: 906-916. doi: 10.1016/j.jcin.2012.06.008
    [10]
    Tegn N, Abdelnoor M, Aaberge L, et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. Lancet 2016; 387: 1057-1065. doi: 10.1016/S0140-6736(15)01166-6
    [11]
    Lourenço C, Teixeira R, Antonio N, et al. Invasive strategy in non-ST elevation acute coronary syndromes: risks and benefits in an elderly population. Rev Port Cardiol 2010; 29: 1451-1472.
    [12]
    Patel KK, Arnold SV, Jones PG, et al. Relation of age and health-related quality of life to invasive versus ischemia-guid ed management of patients with non-ST elevation myocardial infarction. Am J Cardiol 2018; 121: 789-795. doi: 10.1016/j.amjcard.2017.12.034
    [13]
    Sanchis J, Núñez E, Barrabés JA, et al. Randomized com parison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction. Eur J Intern Med 2016; 35: 89-94. doi: 10.1016/j.ejim.2016.07.003
    [14]
    Kolte D, Khera S, Palaniswamy C, et al. Early invasive versus initial conservative treatment strategies in octogenarians with UA/NSTEMI. Am J Med 2013; 126: 1076-1083.e1. doi: 10.1016/j.amjmed.2013.07.024
    [15]
    Saraswat A, Rahman A, Singh K. An invasive vs a conser vative approach in elderly patients with non-ST-segment ele vation myocardial infarction: systematic review and meta- analysis. Can J Cardiol 2018; 34: 274-280. doi: 10.1016/j.cjca.2017.11.020
    [16]
    Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2016; 37: 267-315. doi: 10.1093/eurheartj/ehv320
    [17]
    Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ ACC guideline for the management of patients with non-ST- elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130: 2354-2394. doi: 10.1161/CIR.0000000000000133
    [18]
    Kochar A, Chen AY, Sharma PP, et al. Long-term mortality of older patients with acute myocardial infarction treated in US clinical practice. J Am Heart Assoc 2018; 7: e007230.
    [19]
    Faubert C, Heckman G, McKelvie R. Management of non- ST-elevation myocardial infarction in elderly patients: time to consider frailty and quality of life. Can J Cardiol 2018; 34: 241-243. doi: 10.1016/j.cjca.2018.01.089
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(2)  / Tables(3)

    Article Metrics

    Article views (167) PDF downloads(26) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return