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Jakob P, Lansky AJ, Basir MB, Schonning MJ, Falah B, Zhou Z, Batchelor WB, Abu-Much A, Grines CL, O'Neill WW, Stähli BE. Characteristics and Outcomes of Older Patients Undergoing Protected Percutaneous Coronary Intervention With Impella. J Am Heart Assoc 2025; 14:e038509. [PMID: 40240978 DOI: 10.1161/jaha.124.038509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 02/07/2025] [Indexed: 04/18/2025]
Abstract
BACKGROUND In patients undergoing high-risk percutaneous coronary intervention, Impella has become an important adjunctive tool to support revascularization. The impact of age on the outcomes of patients undergoing high-risk percutaneous coronary intervention is limited. The aim of this study is to describe the characteristics and outcomes of patients ≥75 years of age undergoing Impella-supported high-risk percutaneous coronary intervention. METHODS AND RESULTS Baseline characteristics and outcomes of patients ≥75 years of age versus those of patients <75 years of age in patients enrolled in the cVAD PROTECT III (Catheter-Based Ventricular Assist Device Prospective, Multi-Center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5 System Versus Intra Aortic Balloon Pump in Patients Undergoing Non Emergent High Risk Percutaneous Coronary Intervention) study (NCT04136392). Major adverse cardiovascular and cerebral events (composite of all-cause death, nonfatal myocardial infarction, stroke/transient ischemic attack, and repeat revascularization) were assessed at 30 and 90 days and all-cause death at 1 year. Out of 1237 patients, 493 (39.9%) patients were ≥75 years of age. Patients ≥75 years of age had less diabetes and prior myocardial infarction, more hypertension and dyslipidemia, worse renal function, more severe valvular heart disease, but higher left ventricular ejection fraction (P<0.05 for all comparisons). Baseline Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery scores were similar between groups. Older patients underwent more left main percutaneous coronary intervention (58% versus 39%; P<0.0001), atherectomy (32% versus 22%; P<0.0001), and femoral access (87% versus 79%, P=0.0003) as compared with younger patients. In-hospital vascular complications did not differ, but rates of respiratory failure, pericardial tamponade, and cardiogenic shock were higher in older patients. Rates of all-cause death and major adverse cardiovascular and cerebral events did not differ between groups at 30 and 90 days. Rates of all-cause death at 1 year were higher in patients ≥75 years (adjusted hazard ratio, 1.99 [95% CI, 1.24-3.18], P=0.004). CONCLUSIONS Impella-supported high-risk percutaneous coronary intervention in older patients is feasible with an acceptable safety profile. However, age ≥75 years remained a statistically significant predictor for all-cause death at 1 year. REGISTRATION URL: https://clinicaltrials.gov; Unique Identifier: NCT04136392.
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Affiliation(s)
- Philipp Jakob
- Department of Cardiology, University Heart Center, University Hospital Zurich and the Center for Translational and Experimental Cardiology (CTEC) University of Zurich Zurich Switzerland
| | - Alexandra J Lansky
- Department of Cardiology Yale University School of Medicine New Haven CT USA
| | - Mir B Basir
- Center for Structural Heart Disease, Division of Cardiology Henry Ford Health System Detroit MI USA
| | | | - Batla Falah
- Clinical Trials Center Cardiovascular Research Foundation New York NY USA
| | - Zhipeng Zhou
- Clinical Trials Center Cardiovascular Research Foundation New York NY USA
| | - Wayne B Batchelor
- Inova Center of Outcomes Research Inova Heart and Vascular Institute Falls Church VA USA
| | - Arsalan Abu-Much
- Clinical Trials Center Cardiovascular Research Foundation New York NY USA
| | - Cindy L Grines
- Department of Cardiology Northside Hospital Cardiovascular Institute Atlanta GA USA
| | - William W O'Neill
- Center for Structural Heart Disease, Division of Cardiology Henry Ford Health System Detroit MI USA
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich and the Center for Translational and Experimental Cardiology (CTEC) University of Zurich Zurich Switzerland
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Jafarkhani A, Imani B, Saeedi S, Shams A. Predicting Factors Affecting Survival Rate in Patients Undergoing On-Pump Coronary Artery Bypass Graft Surgery Using Machine Learning Methods: A Systematic Review. Health Sci Rep 2025; 8:e70336. [PMID: 39846048 PMCID: PMC11751876 DOI: 10.1002/hsr2.70336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 12/03/2024] [Accepted: 12/25/2024] [Indexed: 01/24/2025] Open
Abstract
Background and Aim Coronary artery bypass grafting (CABG) is a key treatment for coronary artery disease, but accurately predicting patient survival after the procedure presents significant challenges. This study aimed to systematically review articles using machine learning techniques to predict patient survival rates and identify factors affecting these rates after CABG surgery. Methods From January 1, 2015, to January 20, 2024, a comprehensive literature search was conducted across PubMed, Scopus, IEEE Xplore, and Web of Science. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria included studies that evaluated survival rates and predictors associated with CABG patients during the specified period. Results After eliminating duplicates, a total of 1330 articles were identified. Following a systematic screening, 24 studies met the inclusion criteria. Our findings revealed 43 distinct factors influencing survival rates in patients undergoing CABG. Notably, five factors-age, ejection fraction, diabetes mellitus, a history of cerebrovascular disease or accidents, and renal function-were consistently identified across multiple studies as significant predictors of postsurgical survival. Conclusion This systematic review identifies key factors influencing survival rates after CABG surgery and highlights the role of machine learning in improving predictive accuracy. By identifying high-risk patients through these key factors, our findings offer practical insights for healthcare providers, enhancing patient management and customizing therapeutic strategies after CABG. This study significantly enhances existing literature by combining machine learning techniques with clinical factors, thereby improving the understanding of patient outcomes in CABG surgery.
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Affiliation(s)
- Alireza Jafarkhani
- Department of Operating Room, School of ParamedicineHamadan University of Medical SciencesHamadanIran
| | - Behzad Imani
- Department of Operating Room, School of ParamedicineHamadan University of Medical SciencesHamadanIran
| | - Soheila Saeedi
- Department of Health Information Technology, School of Allied Medical SciencesHamadan University of Medical SciencesHamadanIran
| | - Amir Shams
- Department of Cardiac Surgery, School of MedicineHamadan University of Medical SciencesHamadanIran
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Mª Lourdes DRS, Sergio AR, Francisco ROJ, Blanco-Saez M. Gait speed assessment as a prognostic tool for morbidity and mortality in vulnerable older adult patients following vascular surgery. Geriatr Nurs 2024; 56:25-31. [PMID: 38198923 DOI: 10.1016/j.gerinurse.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Predicting the risk associated with vascular surgery in older adult patients has become increasingly challenging, primarily due to limitations in existing risk assessment tools. This study aimed to evaluate the utility of gait speed, a clinical indicator of frailty, in enhancing the prediction of mortality and morbidity in older adult patients undergoing vascular surgery. METHODS A single-center prospective cohort study was conducted, involving older adult patients undergoing vascular surgery at four tertiary care hospitals between 2021 and 2022. Eligible patients were aged 80 years or older and scheduled for surgical treatment of peripheral arterial disease of the lower limbs (IIb Leriche-Le Fontaine). The primary factor of interest was gait speed, defined as taking more than 6 s to walk 5 meters. The primary outcomes were in-hospital postoperative mortality and major morbidity. RESULTS The cohort comprised 131 patients with a mean age of 82.8 ± 1.4 years, with 34 % being female. Before vascular surgery, 60 patients (46 %) were categorized as slow walkers. Slow walkers were more likely to be female (43 % vs. 25 %, p < 0.03) and diabetic (50 % vs. 28 %, p < 0.01). Among the patients, 30 (23 %) experienced the primary composite outcome of mortality or major morbidity following vascular surgery. After adjusting for the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP®) Surgical Risk Calculator, slow gait speed independently predicted the composite outcome (odds ratio: 3.05; 95 % confidence interval: 1.23 to 7.54). CONCLUSIONS Gait speed is a straightforward and effective test that can help identify a subgroup of frail older adult patients at an elevated and incremental risk of mortality and major morbidity after vascular surgery. While gait speed remains a valuable clinical indicator of frailty, it is important to recognize that the broader context of mobility plays a pivotal role in postoperative outcomes.
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Affiliation(s)
- Del Río-Solá Mª Lourdes
- Department of Surgery, Ophthalmology, Otorhinolaryngology, Physiotherapy. University Clinical Hospital of Valladolid. University of Valladolid. Av. Ramón y Cajal, 7, 47003 Valladolid, Spain.
| | - Asensio-Rodriguez Sergio
- Department of Vascular Surgery. University Clinical Hospital of Valladolid. Av. Ramón y Cajal, 7, 47003 Valladolid, Spain
| | - Roedan-Oliver Joan Francisco
- Department of Vascular Surgery. University Clinical Hospital of Valladolid. Av. Ramón y Cajal, 7, 47003 Valladolid, Spain
| | - Miriam Blanco-Saez
- Department of Cardiovascular Surgery. University Clinical Hospital of Salamanca. P.º de San Vicente, 182, 37007 Salamanca, Spain
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Kirov H, Caldonazo T, Riedel LL, Tasoudis P, Moschovas A, Diab M, Färber G, Doenst T. Comparing outcomes between coronary artery bypass grafting and percutaneous coronary intervention in octogenarians with left main or multivessel disease. Sci Rep 2023; 13:22323. [PMID: 38102297 PMCID: PMC10724226 DOI: 10.1038/s41598-023-49069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
Mechanisms of coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) differ as CABG provides surgical collateralization and may prolong life by preventing future myocardial infarctions (MI). However, CABG benefits are unclear in octogenarians, where surgical risk is often perceived as higher and PCI is chosen more liberally. We performed a meta-analysis of studies comparing outcomes in octogenarians with left main or multivessel disease who underwent CABG or PCI. Primary outcome was late mortality (> 5 years). Secondary outcomes were perioperative mortality, MI, re-revascularization (R-R), acute renal failure (ARF), and stroke. Fourteen studies with 17,942 patients were included. CABG was associated with lower late mortality (hazard ratio, HR: 1.23, 95% confidence interval: CI 1.05-1.44, p < 0.01). In the pooled Kaplan-Meier analysis CABG showed significantly lower risk of death in the follow-up compared to PCI (HR: 1.08, 95%CI 1.02-1.41, p = 0.005). Landmark analyses confirmed the survival advantage of CABG over PCI after 21.5 months of follow-up (HR: 1.31, 1.19-1.44, p < 0.0001), but suggested advantage of PCI over CABG in the first 30-days (HR: 0.72, 0.64-0.82, p < 0.0001) and comparable survival from 1 to 21.5 months (HR: 0.98, 0.92-1.05, p = 0.652). We found lower risk for MI and R-R after CABG but higher perioperative mortality and no differences in ARF and stroke. CABG appears superior to PCI over time in octogenarians with complex CAD. This survival advantage is associated with fewer events of MI and R-R; however, it comes with an increased risk in perioperative mortality.
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Affiliation(s)
- Hristo Kirov
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Tulio Caldonazo
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Leoni Lu Riedel
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Panagiotis Tasoudis
- Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, USA
| | - Alexandros Moschovas
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Mahmoud Diab
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Gloria Färber
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University, Jena, Germany.
- Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Am Klinikum 1, 07747, Jena, Germany.
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Sanchez-Nadales A, Igbinomwanhia E, Grimm RA, Griffin BP, Kapadia SR, Xu B. Contemporary Trends in Clinical Characteristics, Therapeutic Strategies and Outcomes in Patients Aged 80 Years and Older Presenting with non-ST Elevation Myocardial Infarctions in the United States. Curr Probl Cardiol 2023; 48:101993. [PMID: 37487850 DOI: 10.1016/j.cpcardiol.2023.101993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 07/26/2023]
Abstract
The current guidelines for the management and treatment of acute coronary syndromes do not fully consider the role of age in guiding medical or invasive management. We investigated the characteristics, management strategies, and clinical outcomes of patients aged 80 years and older presenting with non-ST elevation myocardial infarction (NSTEMI). A cohort study using the nationwide inpatient sample database of patients aged 80 years and older presenting with NSTEMI in the United States between 2012 to 2018 was performed. About 24.2% (151,472/625,916) of NSTEMI patients were 80 years and older. Older patients (≥80 years) had higher in-hospital mortality and cardiovascular complications compared to younger patients (odds ratio (OR) 1.79, 95% confidence intervals (CI) 1.71-1.88, P < 0.001). Among older patients, conservative medical management was associated with higher inpatient mortality compared to percutaneous coronary intervention (PCI) (OR 2.3, 95% CI 2.18-2.41, P < 0.001) or coronary artery bypass graft (CABG) (OR 1.9, 95% CI 1.76-2.09, P < 0.001). The highest mortality rate was observed in older patients who underwent both PCI and CABG, followed by those treated conservatively and those undergoing coronary angiography without revascularization. This study provides valuable insights into the clinical characteristics and outcomes of elderly patients presenting with NSTEMI in the United States. The results emphasize the importance of a tailored approach to the management of ACS in elderly patients and the need for improved revascularization strategies to reduce in-hospital mortality and adverse cardiovascular outcomes. Therefore, the clinician should tailor the management of older patients presenting with NSTEMI.
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Affiliation(s)
- Alejandro Sanchez-Nadales
- Robert and Suzanne Tomsich Department of Cardiology, Department of Cardiovascular Disease, Cleveland Clinic Florida, FL
| | | | - Richard A Grimm
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Brian P Griffin
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Samir R Kapadia
- Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Bo Xu
- Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH.
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Bayer N, Schmoeckel M, Wohlmuth P, Geidel S. Impact of Graft Strategies on the Outcome of Octogenarians Undergoing Coronary Artery Bypass Grafting. Ann Thorac Cardiovasc Surg 2023; 29:241-248. [PMID: 36990786 PMCID: PMC10587474 DOI: 10.5761/atcs.oa.22-00193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 02/26/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE To analyse the outcome of coronary artery bypass grafting (CABG) in octogenarians with coronary multivessel disease and the impact of different graft strategies and other factors. METHODS Out of 1654 patients with multivessel disease who underwent CABG at our institution between January 2014 and March 2020, we investigated 225 consecutive patients with a median age of 82.1 years for survival prediction and need for coronary reintervention; a detailed outcome analysis was performed. RESULTS At mean follow-up of 3.3 years, the overall survival was 76.4%. An indication for emergency operation (p = 0.002), age (p <0.001), chronic pulmonary disease (p = 0.024), and reduced renal or ventricular function (p <0.001) had the highest impact on limited survival. The combination outcome of survival and coronary reintervention was 1.7-fold improved (p = 0.024) after use of the bilateral internal thoracic artery (BITA) (66.2%). Off-pump CABG (12%) revealed no impact on survival. Smokers showed a poorer outcome (p = 0.004). The logistic European System for Cardiac Operative Risk Evaluation was highly effective for evaluating long-term outcomes (p <0.001). CONCLUSIONS BITA grafting normalizes survival and reveals a better outcome in octogenarians with multivessel disease. However, patients at risk of poorer survival were operated under emergency conditions and those with pulmonary disease and reduced ventricular or renal function.
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Affiliation(s)
- Nicolai Bayer
- Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | - Michael Schmoeckel
- Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
| | | | - Stephan Geidel
- Department of Cardiac Surgery, Asklepios Klinik St. Georg, Hamburg, Germany
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Rufa MI, Ursulescu A, Aktuerk D, Nagib R, Albert M, Göbel N, Shavahatli T, Franke UF. Minimally invasive strategies of surgical coronary artery revascularization for the aging population. THE JOURNAL OF CARDIOVASCULAR SURGERY 2023; 64:534-540. [PMID: 37255493 DOI: 10.23736/s0021-9509.23.12621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND The increasing prevalence of elderly or frail patients with severe coronary disease, who are not suitable for interventional coronary revascularization, necessitates the exploration of alternative treatment options. A less invasive approach, such as minimally-invasive off-pump coronary-artery-bypass (MICS-CABG) grafting through mini-thoracotomy, which avoids both extracorporeal circulation and sternotomy, may be more appropriate for this patient population. This study, a retrospective, monocentric analysis, aimed to evaluate the long-term outcomes of these patients. METHODS The study included 172 patients aged 80 years or older, who underwent MICS-CABG between 2007 and 2018. The patients underwent single, double, or triple-vessel revascularization using the left internal thoracic artery, and in some cases, the radial artery or saphenous vein. Follow-up, mean duration of 50.4±30.8 months, was available for 163 patients (94.7%). RESULTS The mean age of the patients was 83.2±3.0 years, 77.3% of them were male. The EuroSCORE I additive was 11.0±12.1. There were no conversions to sternotomy or cardiopulmonary-bypass. The postoperative 30-day mortality rate was 2.9%, with 5 deaths. The in-hospital rate of major adverse cardiac and cerebrovascular events was 4.7% (perioperative myocardial infarction 1.2%, perioperative stroke 2.3%, repeat revascularization 1.2%). Acute renal kidney injury, (stage 3 KDOQI or more), occurred in 5 patients (2.9%) and new-onset atrial fibrillation in 6 patients (3.5%). The 1-, 3-, 5- and 8-year actuarial survival rate of the 30-day survivors was 97%, 82%, 73%, and 42%, respectively. CONCLUSIONS MICS-CABG grafting is associated with excellent early and long-term outcomes in eligible octogenarians.
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Affiliation(s)
- Magdalena I Rufa
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany -
| | - Adrian Ursulescu
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | | | - Ragi Nagib
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Marc Albert
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Nora Göbel
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Tunjay Shavahatli
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
| | - Ulrich F Franke
- Department of Cardiovascular Surgery, Robert Bosch Hospital, Stuttgart, Germany
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Shimono H, Tokushige A, Kanda D, Ohno A, Hayashi M, Fukuyado M, Akao M, Kawasoe M, Arikawa R, Otsuji H, Chaen H, Okui H, Oketani N, Ohishi M. Association of preoperative clinical frailty and clinical outcomes in elderly patients with stable coronary artery disease after percutaneous coronary intervention. Heart Vessels 2023; 38:1205-1217. [PMID: 37285031 PMCID: PMC10465392 DOI: 10.1007/s00380-023-02276-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/24/2023] [Indexed: 06/08/2023]
Abstract
There are few reports on the long-term clinical outcome after percutaneous coronary intervention (PCI) in patients with stable coronary artery disease (CAD) complicated with frailty. This novel study investigated the association between pre-PCI frailty and long-term clinical outcomes in elderly patients aged 65 years or older with stable CAD who underwent elective PCI. We assessed 239 consecutive patients aged 65 years or older with stable CAD who underwent successful elective PCI at Kagoshima City Hospital between January 1st, 2017 and December 31st, 2020. Frailty was retrospectively assessed using the Canadian Study and Aging Clinical Frailty Scale (CFS). Based on the pre-PCI CFS, patients were divided into two groups: the non-frail (CFS < 5) and the frail (CFS ≥ 5) group. We investigated the association between pre-PCI CFS and major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, and heart failure requiring hospitalization. Additionally, we assessed the association between pre-PCI CFS and major bleeding events defined as Bleeding Academic Research Consortium (BARC) type 3 or 5 bleeding. The mean age was 74.8 ± 7.0 years, and 73.6% were men. According to the pre-PCI frailty assessment, 38 (15.9%) and 201 (84.1%) were classified as frail and non-frail groups, respectively. During a median follow-up of 962 (607-1284) days, 46 patients developed MACEs and 10 patients developed major bleeding events. Kaplan-Meier curves showed a significantly higher incidence of MACE in the frail group compared to those in the non-frail group (Log-rank p < 0.001). Even in multivariate analysis, pre-PCI frailty (CFS ≥ 5) was independently associated with MACE (HR 4.27, 95% CI 1.86-9.80, p-value: < 0.001). Additionally, the cumulative incidence of major bleeding events was significantly higher in the frail group than in the non-frail group (Log-rank p = 0.001). Pre-PCI frailty was an independent risk factor for MACE and bleeding events in elderly patients with stable CAD who underwent elective PCI.
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Affiliation(s)
- Hirokazu Shimono
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Akihiro Tokushige
- Department of Prevention and Analysis of Cardiovascular Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan.
- Department of Clinical Pharmacology and Therapeutics, University of the Ryukyus School of Medicine, Nishihara, Okinawa, Japan.
| | - Daisuke Kanda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ayaka Ohno
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Masao Hayashi
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Mana Fukuyado
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Mitsumasa Akao
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Mariko Kawasoe
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Ryo Arikawa
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Hideaki Otsuji
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Hideto Chaen
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Hideki Okui
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Naoya Oketani
- Department of Cardiovascular Medicine, Kagoshima City Hospital, Kagoshima, Japan
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- Department of Prevention and Analysis of Cardiovascular Diseases, Graduate School of Medical and Dental Sciences, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima, 890-8520, Japan
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Sant’Anna FM, Sant’Anna MB, Sant’Anna LB. Improving Meta-analyses. Arq Bras Cardiol 2023; 120:e20230331. [PMID: 37377260 PMCID: PMC10344416 DOI: 10.36660/abc.20230331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Affiliation(s)
- Fernando Mendes Sant’Anna
- Universidade Federal do Rio de JaneiroMacaéRJBrasilUniversidade Federal do Rio de Janeiro, Campus Macaé, Macaé, RJ – Brasil
- Hospital Santa IzabelCabo FrioRJBrasilHospital Santa Izabel, Cabo Frio, RJ – Brasil
| | - Mariana Bonacossa Sant’Anna
- Fundação Técnico-Educacional Souza MarquesRio de JaneiroRJBrasilFundação Técnico-Educacional Souza Marques (FTESM), Rio de Janeiro, RJ – Brasil
| | - Lucas Bonacossa Sant’Anna
- Fundação Técnico-Educacional Souza MarquesRio de JaneiroRJBrasilFundação Técnico-Educacional Souza Marques (FTESM), Rio de Janeiro, RJ – Brasil
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Hu M, Li X, Yang Y. Invasive Versus Conservative Management of NSTEMI Patients Aged ≥ 75 Years. Arq Bras Cardiol 2023; 120:e20220658. [PMID: 37255135 PMCID: PMC10484564 DOI: 10.36660/abc.20220658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/11/2023] [Accepted: 03/08/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND The efficiency of invasive management in older patients (≥75 years) with non-ST-segment elevation myocardial infarction (NSTEMI) remains ambiguous. OBJECTIVES To assess the efficiency of invasive management in older patients with NSTEMI based on meta-analysis and trial sequential analysis (TSA). METHODS Relevant randomized controlled trials (RCT) and observational studies were included. The primary outcomes were all-cause death, myocardial infarction, stroke, and major bleeding. Pooled odd ratio (OR) and 95% confidence interval (CI) were calculated. P <0.05 was considered statistically significant. RESULTS Five RCTs and 22 observational studies with 1017374 patients were included. Based on RCT and TSA results, invasive management was associated with lower risks of myocardial infarction (OR: 0.51; 95% CI: 0.40-0.65; I2=0%), major adverse cardiovascular events (MACE; OR: 0.61; 95% CI: 0.49-0.77; I2=27.0%), and revascularization (OR: 0.29; 95% CI: 0.15-0.55; I2=5.3%) compared with conservative management. Pooling results from RCTs and observational studies with multivariable adjustment showed consistently lower risks of all-cause death (OR: 0.57; 95% CI: 0.50-0.64; I2=86.4%), myocardial infarction (OR: 0.63; 95% CI: 0.56-0.71; I2=0%), stroke (OR: 0.59; 95% CI: 0.51-0.69; I2=0%), and MACE (OR: 0.64; 95% CI: 0.54-0.76; I2=43.4%). The better prognosis associated with invasive management was also observed in real-world scenarios. However, for patients aged ≥85 years, invasive management may increase the risk of major bleeding (OR: 2.68; 95% CI: 1.12-6.42; I2=0%). CONCLUSIONS Invasive management was associated with lower risks of myocardial infarction, MACE, and revascularization in older patients with NSTEMI, yet it may increase the risk of major bleeding in patients aged ≥85 years.
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Affiliation(s)
- Mengjin Hu
- Fuwai HospitalState Key Laboratory of Cardiovascular DiseaseBeijingChinaFuwai Hospital State Key Laboratory of Cardiovascular Disease, Beijing – China
- Xuanwu HospitalCapital Medical UniversityBeijingChinaXuanwu Hospital, Capital Medical University, Beijing – China
| | - Xiaosong Li
- Fuwai HospitalState Key Laboratory of Cardiovascular DiseaseBeijingChinaFuwai Hospital State Key Laboratory of Cardiovascular Disease, Beijing – China
| | - Yuejin Yang
- Fuwai HospitalState Key Laboratory of Cardiovascular DiseaseBeijingChinaFuwai Hospital State Key Laboratory of Cardiovascular Disease, Beijing – China
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11
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Kodesh A, Bental T, Vaknin-Assa H, Talmor-Barkan Y, Codner P, Levi A, Kornowski R, Perl L. The independent impact of dementia in patients undergoing percutaneous coronary intervention for acute myocardial infarction. Clin Cardiol 2023; 46:279-286. [PMID: 36632766 PMCID: PMC10018096 DOI: 10.1002/clc.23967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/07/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Although age and frailty are associated with worse prognoses for patients who undergo percutaneous coronary intervention (PCI), little is known regarding the independent impact of dementia. HYPOTHESIS The aim of this study was to evaluate the association between dementia and outcomes for patients with acute myocardial infarction (AMI). METHODS Consecutive patients with ST-elevation or non-ST elevation MI who had undergone PCI as part of our AMI registry were included in this study. We compared outcomes within the 1-year period of their PCI, including death and major adverse cardiac events (MACE) and corrected for confounders using Cox regression. RESULTS Of 28 274 patients, 9167 patients who had undergone PCI for AMI were included in this study, 250 with dementia; Mean age (77.4 ± 9.4 in the dementia group vs. 63.6 ± 12.7 in the control), female gender (32.4 vs. 24.2%, p = .003), diabetes mellitus (54.0 vs. 42.4%, p < .001) and chronic kidney disease (44.4 vs. 19.3%, p < .001) were higher. At 12 months, unadjusted rates of death (25.5 vs. 9.8%, p < .001) and MACE (33.8 vs. 17.6%, p < .001) were higher for patients with dementia. After standardizing for confounding variables, dementia remained an independent risk factor for death (HR 1.90; CI 1.37-2.65; p < .001) and MACE (HR 1.73; CI 1.30-2.31; p < .001), as well as in propensity score matched analysis (HR 1.54; CI: 1.03-2.28; p < .001 and HR 1.49; CI: 1.09-2.02; p < .001, respectively). CONCLUSIONS Dementia is an independent predictor of worse outcomes in patients undergoing PCI for AMI. Future intervention and specialized healthcare measures to mitigate this risk is warranted.
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Affiliation(s)
- Afek Kodesh
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Tamir Bental
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Hana Vaknin-Assa
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yeela Talmor-Barkan
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Pablo Codner
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amos Levi
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ran Kornowski
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Leor Perl
- Cardiovascular Department, Rabin Medical Center, Beilinson Hospital, The Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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12
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Cormican DS, Khalif A, McHugh S, Dalia AA, Drennen Z, Nuñez-Gil IJ, Ramakrishna H. Analysis of the Updated ACC/AHA Coronary Revascularization Guidelines With Implications for Cardiovascular Anesthesiologists and Intensivists. J Cardiothorac Vasc Anesth 2023; 37:135-148. [PMID: 36347728 DOI: 10.1053/j.jvca.2022.09.088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/21/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel S Cormican
- Divisions of Cardiothoracic Anesthesiology and Critical Care Medicine, Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA
| | - Adnan Khalif
- Cardiovascular Institute, Allegheny Health Network, Pittsburgh, PA
| | - Stephen McHugh
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Adam A Dalia
- Division of Cardiac Anesthesiology, Department of Critical Care, Anesthesia, and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Zachary Drennen
- Anesthesiology Institute, Allegheny Health Network, Pittsburgh, PA
| | - Ivan J Nuñez-Gil
- Cardiovascular Institute, Hospital Clinico San Carlos, Madrid, Spain
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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13
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Advanced Glycation End Product (AGE) and Soluble Receptor of AGE (sRAGE) Levels in Relation to Periodontitis Severity and as Putative 3-Year Outcome Predictors in Patients Undergoing Coronary Artery Bypass Grafting (CABG). J Clin Med 2022; 11:jcm11144105. [PMID: 35887868 PMCID: PMC9317367 DOI: 10.3390/jcm11144105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 06/22/2022] [Accepted: 07/13/2022] [Indexed: 12/03/2022] Open
Abstract
Tissue concentrations of advanced glycation end product (AGE) and peripheral soluble receptor of AGE (sRAGE) levels may be associated with periodontitis severity. Both parameters and periodontitis might serve as outcome predictors for patients undergoing coronary artery bypass grafting (CABG). This study aimed to investigate possible associations between periodontitis and AGE/sRAGE. Ultimately, we wanted to examine whether AGE, sRAGE, and severe periodontitis are associated with the incidence of new cardiovascular events within 3 years of follow-up after CABG. Ninety-five patients with coronary vascular disease (CVD) (age 69 years, 88.3% males) needing CABG surgery were included. Periodontal diagnosis was made according to the guidelines of the “Centers for Disease Control and Prevention (CDC)” (2007) and staged according to the new classification of periodontal diseases (2018). AGE tissue concentrations were assessed as skin autofluorescence (sAF). sRAGE levels were determined by using a commercially available enzyme-linked immunoabsorbance assay (ELISA) kit. Univariate and multivariate baseline and survival analyses were carried out with Mann–Whitney U test, Chi² test, Kaplan–Meier curves with Log-Rank test, and logistic and Cox regression. sAF was identified as an independent risk indicator for severe periodontitis with respect to the cofactors age, gender, plaque index, and diabetes (adjusted odds ratio [OR] = 2.9, p = 0.028). The degree of subgingival inflammation assessed as a percentage of sites with bleeding on probing (BOP) was inversely correlated with sRAGE concentration (r = −0.189, p = 0.034). Both sAF (Hazard Ratio [HR] = 2.4, p = 0.004) and sRAGE (HR = 1.9, p = 0.031) increased the crude risk for new adverse events after CABG. The occurrence of severe periodontitis trends towards a higher risk for new cardiovascular events (HR = 1.8, p = 0.115). Applying multivariate Cox regression, only peripheral arterial disease (adjusted HR = 2.7, p = 0.006) and history of myocardial infarction (adjusted HR = 2.8, p = 0.010) proved to be independent risk factors for cardiovascular outcome. We conclude that sAF may represent a new, independent risk indicator for severe periodontitis. In contrast, sAF, sRAGE, and severe periodontitis were not independent prognostic factors for postoperative outcome in patients undergoing CABG.
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14
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Ismayl M, Machanahalli Balakrishna A, Walters RW, Pajjuru VS, Goldsweig AM, Aboeata A. In-hospital mortality and readmission after ST-elevation myocardial infarction in nonagenarians: A nationwide analysis from the United States. Catheter Cardiovasc Interv 2022; 100:5-16. [PMID: 35568973 DOI: 10.1002/ccd.30227] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 04/14/2022] [Accepted: 05/03/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To assess readmission rates in nonagenarians (age ≥ 90 years) with ST-elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) versus no pPCI. BACKGROUND There are limited data exploring readmissions following STEMI in nonagenarians undergoing pPCI versus no pPCI. METHODS We retrospectively analyzed the Nationwide Readmissions Database to identify nonagenarians hospitalized with STEMI. We divided the cohort into two groups based on pPCI status. We compared mortality during index hospitalization and during 30-day readmission, readmission rates, and causes of readmissions. RESULTS We identified 58,231 nonagenarian STEMI hospitalizations between 2010 and 2018, of which 18,809 (32.3%) included pPCI, and 39,422 (67.7%) had no pPCI. Unadjusted unplanned 30-day readmission was higher in pPCI cohort (21.0% vs. 15.4%, p < 0.001). However, mortality during index hospitalization and during 30-day readmission were significantly lower in pPCI cohort (15.8% vs. 32.2%, p < 0.001; 7.4% vs. 14.2%, p < 0.001, respectively). After adjusting for baseline characteristics, hospitalizations that included pPCI had 25% greater odds of unplanned 30-day readmission (adjusted odds ratio [aOR]: 1.25, 95% confidence interval [CI]: 1.12-1.39, p < 0.001) and 49% lower odds of in-hospital mortality during index hospitalization (aOR: 0.51, 95% CI: 0.46-0.56, p < 0.001). Heart failure was the most common cause of readmission in both cohorts followed by myocardial infarction. CONCLUSIONS In nonagenarians with STEMI, pPCI is associated with slightly higher 30-day readmission but significantly lower mortality during index hospitalization and during 30-day readmission than no pPCI. Given the overwhelming mortality benefit with pPCI, further research is necessary to optimize the utilization of pPCI while reducing readmissions following STEMI in nonagenarians.
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Affiliation(s)
- Mahmoud Ismayl
- Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | | | - Ryan W Walters
- Division of Clinical Research and Evaluative Sciences, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Venkata S Pajjuru
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
| | - Andrew M Goldsweig
- Division of Cardiology, Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ahmed Aboeata
- Division of Cardiology, Department of Medicine, Creighton University School of Medicine, Omaha, Nebraska, USA
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15
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Achim A, Marc M, Ruzsa Z. Surgical Turned-Downed CHIP Cases—Can PCI Save the Day? Front Cardiovasc Med 2022; 9:872398. [PMID: 35463754 PMCID: PMC9021524 DOI: 10.3389/fcvm.2022.872398] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 03/21/2022] [Indexed: 01/19/2023] Open
Abstract
Current guidelines, rarely if at all, address decision-making for revascularization when bypass surgery is not a possibility for high-risk cases. Patients who are surgically turned down are routinely excluded from clinical trials, even though they remain symptomatic. Furthermore, the reasons for surgical ineligibility are often times not captured in standardized risk models. There is no data regarding health status outcomes following PCI procedures in these patients and the ultimate question remains whether the benefits of PCI outweigh its risks in this controversial subpopulation. When CHIP (Complex High risk Indicated Percutaneous coronary interventions) is selected for these very complex individuals, there is no unanimity regarding the goals for interventional revascularization (for instance, the ambition to achieve completeness of revascularization vs. more targeted or selective PCI). The recognition that, worldwide, these patients are becoming increasingly prevalent and increasingly commonplace in the cardiac catheterization labs, along with the momentum for more complex interventional procedures and expanding skillsets, gives us a timely opportunity to better examine the outcomes for these patients and inform clinical decision-making.
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Affiliation(s)
- Alexandru Achim
- “Niculae Stancioiu” Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
- Klinik für Kardiologie, Medizinische Universitätsklinik, Kantonsspital Baselland, Liestal, Switzerland
- Division of Invasive Cardiology, 2nd Department of Internal Medicine, University of Szeged, Szeged, Hungary
- *Correspondence: Alexandru Achim
| | - Madalin Marc
- “Niculae Stancioiu” Heart Institute, University of Medicine and Pharmacy “Iuliu Hatieganu”, Cluj-Napoca, Romania
| | - Zoltan Ruzsa
- Division of Invasive Cardiology, 2nd Department of Internal Medicine, University of Szeged, Szeged, Hungary
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16
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Blessing RRL, Ahoopai M, Geyer M, Brandt M, Zeiher AM, Vasa-Nicotera M, Münzel T, Wenzel P, Gori T, Dimitriadis Z. Percutaneous coronary intervention for chronic total occlusion in octogenarians: a propensity score study. Sci Rep 2022; 12:3073. [PMID: 35197506 PMCID: PMC8866394 DOI: 10.1038/s41598-022-06994-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 02/09/2022] [Indexed: 11/09/2022] Open
Abstract
Feasibility and efficacy of complex percutaneous coronary intervention (PCI) in the elderly, a more frail population due to more comorbidities is incompletely understood. We therefore set out to compare success and complication rate of PCI for chronic total occlusion (CTO) in octogenarians, in comparison to non-octogenarians. Data from 267 patients (58 patients over 80 years of age and 209 under 80 years of age) who had undergone CTO PCI were analyzed. To compare the results we calculated the propensity score and used inverse probability of treatment weighting. We evaluated demographic, clinical, angiographic, and periprocedural information. The median age of the total collective was 68 (31–90) years (octogenarian collective 82 (80–90) years vs non-octogenarians 65 (31–79) years). We observed a high success rate in both collectives (82.8% vs 90.4%, p = 0.10) and no difference in periprocedural complications or complications in the follow-up period. In our collective restenosis rate at follow-up was comparable to the propensity sore weighted population (11.3% vs 16.3%, p = 0.9). Our results show that CTO PCI in older patients is safe and feasible with comparable in-hospital and follow-up complication rates compared to a younger patient population.
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Affiliation(s)
- Recha R L Blessing
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany.
| | - Majid Ahoopai
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany
| | - Martin Geyer
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany
| | - Moritz Brandt
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, Mainz, Germany
| | - Andreas M Zeiher
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Mariuca Vasa-Nicotera
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany
| | - Thomas Münzel
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Philip Wenzel
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany.,Center for Thrombosis and Hemostasis (CTH), Johannes Gutenberg University, Mainz, Germany
| | - Tommaso Gori
- Department of Cardiology, University Medical Center Mainz - Center of Cardiology, Johannes Gutenberg University, Langenbeckstr.1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Zisis Dimitriadis
- Department of Cardiology, Center of Internal Medicine, Goethe University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany.
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17
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79:e21-e129. [PMID: 34895950 DOI: 10.1016/j.jacc.2021.09.006] [Citation(s) in RCA: 771] [Impact Index Per Article: 257.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIM The guideline for coronary artery revascularization replaces the 2011 coronary artery bypass graft surgery and the 2011 and 2015 percutaneous coronary intervention guidelines, providing a patient-centric approach to guide clinicians in the treatment of patients with significant coronary artery disease undergoing coronary revascularization as well as the supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from May 2019 to September 2019, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Collaboration, CINHL Complete, and other relevant databases. Additional relevant studies, published through May 2021, were also considered. STRUCTURE Coronary artery disease remains a leading cause of morbidity and mortality globally. Coronary revascularization is an important therapeutic option when managing patients with coronary artery disease. The 2021 coronary artery revascularization guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with coronary artery disease who are being considered for coronary revascularization, with the intent to improve quality of care and align with patients' interests.
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18
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Lawton JS, Tamis-Holland JE, Bangalore S, Bates ER, Beckie TM, Bischoff JM, Bittl JA, Cohen MG, DiMaio JM, Don CW, Fremes SE, Gaudino MF, Goldberger ZD, Grant MC, Jaswal JB, Kurlansky PA, Mehran R, Metkus TS, Nnacheta LC, Rao SV, Sellke FW, Sharma G, Yong CM, Zwischenberger BA. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2022; 145:e18-e114. [PMID: 34882435 DOI: 10.1161/cir.0000000000001038] [Citation(s) in RCA: 263] [Impact Index Per Article: 87.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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19
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Revascularization Strategies for Multivessel Coronary Artery Disease in the Elderly Population. J Surg Res 2021; 270:444-454. [PMID: 34798427 DOI: 10.1016/j.jss.2021.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 09/23/2021] [Accepted: 10/10/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Prospective trials comparing coronary artery bypass grafting (CABG) with percutaneous coronary intervention (PCI) for the treatment of multivessel coronary disease (MVCAD) have included mostly younger patients. We compared treatment strategies in the elderly population. MATERIALS AND METHODS We performed a propensity-score-matched comparison of patients ≥75 y who underwent isolated CABG or PCI for MVCAD between 2011 and 2018, excluding those with prior cardiac surgery and/or significant left main disease. The primary outcome was 5-year Kaplan Meier survival, and secondary outcomes included readmissions and major adverse cardiovascular and cerebrovascular events (MACCE). RESULTS Propensity-matching yielded 536 patients (266 PCI and 266 CABG). Rates of complete revascularization of all stenotic lesions were higher in the CABG arm (86.8% versus 21.8%; P < 0.001). Thirty-d mortality was similar between cohorts, though PCI recipients had shorter hospital stay and greater likelihood of discharge to home. Unadjusted one- (89.1% versus 88.4%) and 5-year (73.8% versus 60.1%) survival were both higher in patients who underwent CABG (P = 0.0332). Patients undergoing CABG had reduced, but nonsignificant cumulative incidence of all-cause hospital readmission and MACCE at 5 y. Subgroup analysis of patients 80 y or older revealed similar late survival benefit with CABG when compared to PCI. Among patients undergoing CABG, there did not appear to be any 5-year benefits from multi-arterial grafting. CONCLUSIONS Despite longer hospitalization and higher rate of nonhome discharge, CABG was associated with improved late survival over PCI in the elderly population. Cardiac surgeons should be included in the multidisciplinary evaluation of older patients with MVCAD.
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20
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Kobo O, Moledina SM, Slawnych M, Sinnarajah A, Simon J, Van Spall HGC, Sun LY, Zoccai GB, Roguin A, Mohamed MO, Mamas MA. Predictors, Treatments, and Outcomes of Do-Not-Resuscitate Status in Acute Myocardial Infarction Patients (from a Nationwide Inpatient Cohort Study). Am J Cardiol 2021; 159:8-18. [PMID: 34656317 DOI: 10.1016/j.amjcard.2021.07.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 02/05/2023]
Abstract
Little is known about how frequently do-not-resuscitate (DNR) orders are placed in patients with acute myocardial infarction (AMI), the types of patients in which they are placed, treatment strategies or clinical outcomes of such patients. Using the United States (US) National Inpatient Sample (NIS) database from 2015 to 2018, we identified 2,767,549 admissions that were admitted to US hospitals and during the hospitalization received a principle diagnosis of AMI, of which 339,270 (12.3%) patients had a DNR order (instigated both preadmission and during in-hospital stay). Patients with a DNR status were older (median age 83 vs 65, p < 0.001), more likely to be female (53.4% vs 39.3%, p < 0.001) and White (81.0% vs 73.3%, p < 0.001). Predictors of DNR status included comorbidities such as heart failure (OR: 1.47, 95% CI: 1.45 to 1.48), dementia (OR: 2.53, 95% CI: 2.50 to 2.55), and cancer. Patients with a DNR order were less likely to undergo invasive management or be discharged home (13.5% vs 52.8%), with only 1/3 receiving palliative consultation. In hospital mortality (32.7% vs 4.6%, p < 0.001) and MACCE (37.1% vs 8.8%, p < 0.001) were higher in the DNR group. Factors independently associated with in-hospital mortality among patients with a DNR order included a STEMI presentation (OR: 2.90, 95% CI: 2.84 to 2.96) and being of Black (OR: 1.29, 95% CI: 1.26 to 1.33), Hispanic (OR: 1.36, 95% CI: 1.32 to 1.41) or Asian/Pacific Islander (OR: 1.56, 95% CI:1.49-race. In conclusion, AMI patients with a DNR status were older, multimorbid, less likely to receive invasive management, with only one third of patients with DNR status referred for palliative care.
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Affiliation(s)
- Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera, Israel; Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
| | - Saadiq M Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
| | - Michael Slawnych
- Libin Cardiovascular Institute and Division of Palliative care, Department of Oncology, University of Calgary, Alberta, Canada
| | | | - Jessica Simon
- Department of Oncology, University of Calgary, Alberta, Canada
| | - Harriette G C Van Spall
- Department of Medicine and Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, and Population Health Research Institute, Canada
| | - Louise Y Sun
- Division of Cardiac Anesthesiology, University of Ottawa Heart Institute, and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Mediterranea Cardiocentro, Napoli, Italy
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera, Israel
| | - Mohamed O Mohamed
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, United Kingdom; Department of Cardiology, Jefferson University, Philadelphia, Pennsylvania.
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21
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Kitamura H, Tamaki M, Kawaguchi Y, Okawa Y. Results of off-pump coronary artery bypass grafting with off-pump first strategy in octogenarian. J Card Surg 2021; 36:4611-4616. [PMID: 34613636 PMCID: PMC9291825 DOI: 10.1111/jocs.16055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 09/13/2021] [Indexed: 11/28/2022]
Abstract
Background and Aim Ischemic heart disease is the leading cause of death around the world. Coronary artery bypass grafting offers efficient surgical revascularization for ischemic disease. Both on‐ or off‐pump coronary artery bypass methods provide promising results to octogenarians, once complete vascularization is achieved. However, off‐pump bypass requires a certain level of experience to achieve sufficient results. We have applied an off‐pump coronary artery bypass‐first strategy to all generations since 2008. This study investigated early and long‐term results of surgical revascularization for octogenarians by a team with an off‐pump‐first strategy. Methods All cases of isolated coronary artery bypass grafting performed since 2008 were identified and divided into a young group (age < 80 years) and an old group (age ≥ 80 years). Peri‐operative results were investigated retrospectively in both groups and long‐term results for the old group were assessed. Results Among the 707 patients, 97% underwent off‐pump bypass, and 94 cases were classified to the old group. Distal anastomoses and ventilator time were identical between groups (young vs. old: 3.3 vs. 3.2; 3.7 h vs. 3.7 h). In‐hospital death rates were 0.5% and 0% in the young and old groups, respectively. With a mean follow‐up of 1318 days, actual 1‐, 3‐, and 5‐year survival rates for octogenarians were 92.1%, 81.2%, and 68.3%, respectively. Nearly half of the patients reached their nineties, which was close to the life expectancy of the national general octogenarian. Conclusions An experienced team with an off‐pump‐first strategy could provide valid therapeutic options for octogenarians.
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Affiliation(s)
- Hideki Kitamura
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Mototsugu Tamaki
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhiko Kawaguchi
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
| | - Yasuhide Okawa
- Department of Cardiovascular Surgery, Nagoya Heart Center, Nagoya, Aichi, Japan
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22
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Mlynarska A, Mlynarski R, Uchmanowicz B, Mikuľáková W. Can Frailty Be a Predictor of ICD Shock after the Implantation of a Cardioverter Defibrillator in Elderly Patients? SENSORS (BASEL, SWITZERLAND) 2021; 21:6299. [PMID: 34577506 PMCID: PMC8470717 DOI: 10.3390/s21186299] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/12/2021] [Accepted: 09/18/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The aim of the study was to assess the prevalence of frailty among elderly patients who had an implanted cardioverter defibrillator, as well as the influence of frailty on the main endpoints during the follow-up. METHODS The study included 103 patients > 60 years of age (85M, aged 71.56-8.17 years). All of the patients had an implanted single or dual-chamber cardioverter-defibrillator. In the research, there was a 12-month follow-up. The occurrence of frailty syndrome was assessed using the Tilburg Frailty Indicator scale (TFI). RESULTS Frailty syndrome was diagnosed in 75.73% of the patients that were included in the study. The mean values of the TFI were 6.55 ± 2.67, in the physical domain 4.06 ± 1.79, in the psychological domain 2.06 ± 1.10, and in the social domain 0.44 ± 0.55. During the follow-up period, 27.2% of patients had a defibrillator cardioverter electric shock, which occurred statistically more often in patients with diagnosed frailty syndrome (34.6%) compared to the robust patients (4%); p = 0.0062. In the logistic regression, frailty (OR: 1.203, 95% CI:1.0126-1.4298; p < 0.030) was an independent predictor of a defibrillator cardioverter electric shock. Similarly, in the logistic regression, frailty (OR: 1.3623, 95% CI:1.0290-1.8035; p = 0.019) was also an independent predictor for inadequate electric shocks. CONCLUSION About three-quarters of the elderly patients that had qualified for ICD implantation were affected by frailty syndrome. In the frailty subgroup, adequate and inadequate shocks occurred more often compared to the robust patients.
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Affiliation(s)
- Agnieszka Mlynarska
- Department of Gerontology and Geriatric Nursing, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
- Upper Silesian Heart Centre, Department of Electrocardiology, 40-055 Katowice, Poland;
| | - Rafal Mlynarski
- Upper Silesian Heart Centre, Department of Electrocardiology, 40-055 Katowice, Poland;
- Department of Electrocardiology and Heart Failure, School of Health Sciences, Medical University of Silesia, 40-635 Katowice, Poland
| | - Bartosz Uchmanowicz
- Department of Clinical Nursing, Faculty of Health Sciences, Wroclaw Medical University, 51-618 Wroclaw, Poland;
| | - Wioletta Mikuľáková
- Department of Physiotherapy, Faculty of Health Care, University of Presov, Partizánska 1, 08001 Presov, Slovakia;
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23
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Anand PA, Keshavamurthy S, Shelley EM, Saha S. Does Age Affect the Short- and Long-Term Outcomes of Coronary Bypass Grafting? Int J Angiol 2021; 30:202-211. [PMID: 34776820 PMCID: PMC8580610 DOI: 10.1055/s-0041-1735221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The etiology of coronary artery disease (CAD) is multifactorial, stemming from both modifiable and nonmodifiable risk factors such as age. Several studies have reported the effects of age on various outcomes of coronary artery bypass grafting (CABG). This article reviews age-related outcomes of CABG and offers direction for further studies in the field to create comprehensive, evidence-based guidelines for the treatment of CAD. Ninety-two primary sources were analyzed for relevance to the subject matter, of which 17 were selected for further analysis: 14 retrospective cohort studies, 2 randomized clinical trials, and 1 meta-analysis. Our review revealed four broad age ranges into which patients can be grouped: those with CAD (1) below the age of 40 years, (2) between the ages of 40 and 60 years, (3) between the ages of 60 and 80 years, and (4) at or above 80 years. Patients below the age of 40 years fare best overall with total arterial revascularization (TAR). Patients between the ages of 40 and 60 years also fare well with the use of multiarterial grafts (MAGs) whereas either MAGs or single-arterial grafts may be of significant benefit to patients at or above the age of 60 years, with younger and diabetic patients benefitting the most. Arterial grafting is superior to vein grafting until the age of 80 years, at which point there is promising evidence supporting the continued use of the saphenous vein as the favored graft substrate. Age is a factor affecting the outcomes of CABG but should not serve as a barrier to offering patients CABG at any age from either a cost or a health perspective. Operative intervention starts to show significant mortality consequences at the age of 80 years, but the increased risk is countered by maintenance or improvement to patients' quality of life.
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Affiliation(s)
- Pavan Ashwini Anand
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Suresh Keshavamurthy
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Ellis M. Shelley
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
| | - Sibu Saha
- Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky
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24
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[Acute coronary syndrome in the elderly emergency department: diagnosis and management]. SOINS. GÉRONTOLOGIE 2021; 26:19-23. [PMID: 34462107 DOI: 10.1016/j.sger.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Acute coronary syndrome (ACS) is a pathology frequently encountered in emergency rooms, especially in the elderly. Caregivers must know how to recognize an ACS despite an often heterogeneous and atypical presentation. Management should include an overall assessment of the patient in order to decide on the best management for the patient.
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25
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Very long-term outcomes of older adults with stable coronary artery disease (from the CORONOR study). Coron Artery Dis 2021; 33:169-175. [PMID: 34380959 DOI: 10.1097/mca.0000000000001086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There are limited data on stable coronary artery disease (CAD) in the very elderly. The present study aimed to investigate incident cardiovascular events and mortality in older adults (≥85 years) included in a multicenter registry on stable CAD. METHODS A long-term follow-up was performed in 198 patients ≥85 years with stable CAD, free from myocardial infarction (MI) or coronary revascularization within the year. The median age was 87 years. Clinical events during the follow-up period [death, MI, ischemic stroke, coronary revascularization and hospitalization for heart failure (HF)] were centrally adjudicated. RESULTS There were 164 deaths during follow-up. The cumulative risk of all-cause death was 9.1% at 1 year, 53.9% at 5 years and 85.5% at 10 years. The cause of death was adjudicated as cardiovascular in 64 patients with death from HF in 36 patients. Male gender, previous hospitalization for HF and an estimated glomerular filtration rate <60 ml/min/1.73 m2 were independently associated with all-cause death. Ten-year cumulative incidences of MI, ischemic stroke and coronary revascularization were low (6.6, 7.7 and 6.6%, respectively). By contrast, the 10-year cumulative incidence of hospitalization for HF was high (27.8%). CONCLUSION The 10-year mortality of elderly patients with stable CAD is very high. While ischemic events are relatively unfrequent, HF events are frequent and represent the most common cause of cardiovascular death in this population. Prevention and management of HF are important goals for physicians in charge of older adults with stable CAD.
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26
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Phan DQ, Zadegan R, Lee MS. Revascularization versus medical therapy in patients aged 80 and older with stable ischemic heart disease. J Am Geriatr Soc 2021; 69:3457-3467. [PMID: 34363216 DOI: 10.1111/jgs.17404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Older patients are underrepresented in landmark randomized trials for stable ischemic heart disease (SIHD). Therefore, we sought to evaluate the benefits of revascularization in patients ≥80 years old with SIHD. METHODS Retrospective study of patients undergoing invasive coronary angiography (ICA) for SIHD between 2009 and 2019. Patients were grouped according to treatment: revascularization (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) versus initial medical therapy alone. Inverse probability of treatment weighting (IPTW)-adjusted Cox proportional hazard regression analyses were performed. Outcomes evaluated were all-cause mortality, non-fatal myocardial infarction (MI), and repeat revascularization. RESULTS A total of 1015 patients (median age 83.0, interquartile range [IQR] 81.3-85.2 years; 29% female) underwent ICA for SIHD. Of these, 557 (55%) were treated with revascularization and 458 (45%) with initial medical therapy alone. Baseline characteristics were well balanced after IPTW adjustment. At median follow-up of 3.5 years (IQR 1.7-5.9 years), there were no differences in all-cause mortality and non-fatal MI between treatment groups; but there was an increased need for repeat revascularization (IPTW adjusted hazard ratio 2.22, 95% confidence interval 1.53-3.22) with revascularization. Separately comparing PCI or CABG alone versus medical therapy yielded similar results; as well as in subgroup analysis (except for patients ≥90 years old and those without prior CABG). CONCLUSION There were no differences in all-cause mortality and non-fatal MI with invasive revascularization (either PCI or CABG) versus medical therapy alone in patients ≥80 years old with SIHD. Large randomized trials focusing on older patients are warranted to guide clinical practice in this growing population.
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Affiliation(s)
- Derek Q Phan
- Regional Cardiac Catheterization Lab, Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Ray Zadegan
- Regional Cardiac Catheterization Lab, Kaiser Permanente Southern California, Los Angeles, California, USA
| | - Ming-Sum Lee
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA
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27
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Vu M, Koponen M, Taipale H, Kettunen R, Hartikainen S, Tolppanen AM. Coronary Revascularization and Postoperative Outcomes in People With and Without Alzheimer's Disease. J Gerontol A Biol Sci Med Sci 2021; 76:1524-1530. [PMID: 33420783 PMCID: PMC8277078 DOI: 10.1093/gerona/glab006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Little is known on the incidence and postoperative outcomes of revascularizations according to electivity in persons with Alzheimer's disease (AD). METHODS The Medication Use and Alzheimer's disease (MEDALZ) cohort includes 70 718 community dwellers diagnosed with incident AD during 2005-2011 in Finland. For each person with AD, 1-4 age-, sex-, and hospital district-matched comparison persons without AD were identified. Altogether 448 persons with AD and 5909 without AD underwent revascularization during the follow-up. The outcomes were 30-day and 90-day re-admission rate after discharge, and all-cause 1-year and 3-year mortality. Risk of outcomes in persons with AD were compared to those without AD using Cox proportional hazard models adjusted with age, sex, comorbidities, statin use, revascularization type, length of stay, and support at discharge. RESULT People with AD had less revascularizations (adjusted hazard ratio 0.24, 95% confidence interval 0.22-0.27). Emergency procedures were more common (42.6% vs 33.1%) than elective procedures (34.2% vs 48.6%) among people with AD. There was no difference in 30-day readmissions (0.97, 0.80-1.17) or 1-year mortality (1.04, 0.75-1.42) and 90 days readmission risk was lower in persons with AD (0.85, 0.74-0.98). People with AD had higher 3-year mortality (1.42, 1.15-1.74), but the risk increase was observed only for emergency (1.71, 1.27-2.31), not for elective procedures (0.96, 0.63-1.46). CONCLUSION People with AD did not have worse readmission and mortality outcomes following elective revascularization. These findings in conjunction with lower revascularization rate especially for elective procedures raise questions on the threshold for elective procedures in people with AD.
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Affiliation(s)
- Mai Vu
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio
- Faculty of Pharmacy, Ho Chi Minh City University of Technology – HUTECH, Vietnam
| | - Marjaana Koponen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Heidi Taipale
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Raimo Kettunen
- School of Medicine, University of Eastern Finland, Kuopio
| | - Sirpa Hartikainen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio
| | - Anna-Maija Tolppanen
- Kuopio Research Centre of Geriatric Care, School of Pharmacy, University of Eastern Finland, Kuopio
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28
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Yuan D, Jia S, Zhang C, Jiang L, Xu L, Zhang Y, Xu J, Liu R, Xu B, Hui R, Gao R, Gao Z, Song L, Yuan J. Real-world long-term outcomes based on three therapeutic strategies in very old patients with three-vessel disease. BMC Cardiovasc Disord 2021; 21:316. [PMID: 34187370 PMCID: PMC8243749 DOI: 10.1186/s12872-021-02067-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 05/17/2021] [Indexed: 11/25/2022] Open
Abstract
Background There are relatively limited data regarding real-world outcomes in very old patients with three-vessel disease (3VD) receiving different therapeutic strategies. This study aimed to perform analysis of long-term clinical outcomes of medical therapy (MT), coronary artery bypass grafting (CABG), and percutaneous coronary intervention (PCI) in this population. Methods We included 711 patients aged ≥ 75 years from a prospective cohort of patients with 3VD. Consecutive enrollment of these patients began from April 2004 to February 2011 at Fu Wai Hospital. Patients were categorized into three groups (MT, n = 296; CABG, n = 129; PCI, n = 286) on the basis of different treatment strategies. Results During a median follow-up of 7.25 years, 262 deaths and 354 major adverse cardiac and cerebrovascular events (MACCE) occurred. Multivariate Cox analysis showed that the risk of cardiac death was significantly lower for CABG compared with PCI (adjusted hazard ratio [HR] = 0.475, 95% confidence interval [CI] 0.232–0.974, P = 0.042). Additionally, MACCE appeared to show a trend towards a better outcome for CABG (adjusted HR = 0.759, 95% CI 0.536–1.074, P = 0.119). Furthermore, CABG was significantly superior in terms of unplanned revascularization (adjusted HR = 0.279, 95% CI 0.079–0.982, P = 0.047) and myocardial infarction (adjusted HR = 0.196, 95% CI 0.043–0.892, P = 0.035). No significant difference in all-cause death between CABG and PCI was observed. MT had a higher risk of cardiac death than PCI (adjusted HR = 1.636, 95% CI 1.092–2.449, P = 0.017). Subgroup analysis showed that there was a significant interaction between treatment strategy (PCI vs. CABG) and sex for MACCE (P = 0.026), with a lower risk in men for CABG compared with that of PCI, but not in women. Conclusions CABG can be performed with reasonable results in very old patients with 3VD. Sex should be taken into consideration in therapeutic decision-making in this population. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-021-02067-6.
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Affiliation(s)
- Deshan Yuan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Sida Jia
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Ce Zhang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Lin Jiang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Lianjun Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Yin Zhang
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Jingjing Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Ru Liu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Rutai Hui
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Runlin Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Zhan Gao
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China
| | - Lei Song
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China.
| | - Jinqing Yuan
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, No. 167, Beilishi Rd, Xicheng District, Beijing, 100037, China.
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Soangra R, Lockhart T. Smartphone-Based Prediction Model for Postoperative Cardiac Surgery Outcomes Using Preoperative Gait and Posture Measures. SENSORS 2021; 21:s21051704. [PMID: 33801240 PMCID: PMC7958120 DOI: 10.3390/s21051704] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/16/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022]
Abstract
Gait speed assessment increases the predictive value of mortality and morbidity following older adults' cardiac surgery. The purpose of this study was to improve clinical assessment and prediction of mortality and morbidity among older patients undergoing cardiac surgery through the identification of the relationships between preoperative gait and postural stability characteristics utilizing a noninvasive-wearable mobile phone device and postoperative cardiac surgical outcomes. This research was a prospective study of ambulatory patients aged over 70 years undergoing non-emergent cardiac surgery. Sixteen older adults with cardiovascular disease (Age 76.1 ± 3.6 years) scheduled for cardiac surgery within the next 24 h were recruited for this study. As per the Society of Thoracic Surgeons (STS) recommendation guidelines, eight of the cardiovascular disease (CVD) patients were classified as frail (prone to adverse outcomes with gait speed ≤0.833 m/s) and the remaining eight patients as non-frail (gait speed >0.833 m/s). Treating physicians and patients were blinded to gait and posture assessment results not to influence the decision to proceed with surgery or postoperative management. Follow-ups regarding patient outcomes were continued until patients were discharged or transferred from the hospital, at which time data regarding outcomes were extracted from the records. In the preoperative setting, patients performed the 5-m walk and stand still for 30 s in the clinic while wearing a mobile phone with a customized app "Lockhart Monitor" available at iOS App Store. Systematic evaluations of different gait and posture measures identified a subset of smartphone measures most sensitive to differences in two groups (frail versus non-frail) with adverse postoperative outcomes (morbidity/mortality). A regression model based on these smartphone measures tested positive on five CVD patients. Thus, clinical settings can readily utilize mobile technology, and the proposed regression model can predict adverse postoperative outcomes such as morbidity or mortality events.
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Affiliation(s)
- Rahul Soangra
- Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA 92866, USA;
- Fowler School of Engineering, Chapman University, Orange, CA 92866, USA
| | - Thurmon Lockhart
- School of Biological and Health Systems Engineering, Arizona State University, Tempe, AZ 85287, USA
- Correspondence: ; Tel.: +1-540-257-3058
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Is Periodontitis a Predictor for an Adverse Outcome in Patients Undergoing Coronary Artery Bypass Grafting? A Pilot Study. J Clin Med 2021; 10:jcm10040818. [PMID: 33671402 PMCID: PMC7922110 DOI: 10.3390/jcm10040818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 12/31/2022] Open
Abstract
Periodontitis is a risk factor for atherosclerosis and coronary vascular disease (CVD). This research evaluated the relationship between periodontal conditions and postoperative outcome in patients who underwent coronary artery bypass grafting (CABG). A total of 101 patients with CVD (age 69 years, 88.1% males) and the necessity of CABG surgery were included. Periodontal diagnosis was made according to the guidelines of the Centers for Disease Control and Prevention (CDC, 2007). Additionally, periodontal epithelial surface area (PESA) and periodontal inflamed surface area (PISA) were determined. Multivariate survival analyses were carried out after a one-year follow-up period with Cox regression. All study subjects suffered from periodontitis (28.7% moderate, 71.3% severe). During the follow-up period, 14 patients (13.9%) experienced a new cardiovascular event (11 with angina pectoris, 2 with cardiac decompensation, and 1 with cardiac death). Severe periodontitis was not significant associated with the incidence of new events (adjusted hazard ratio, HR = 2.6; p = 0.199). Other risk factors for new events were pre-existing peripheral arterial disease (adjusted HR = 4.8, p = 0.030) and a history of myocardial infarction (HR = 6.1, p = 0.002). Periodontitis was not found to be an independent risk factor for the incidence of new cardiovascular events after CABG surgery.
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Shields MC, Ouellette M, Kiefer N, Kohan L, Taylor AM, Ailawadi G, Ragosta M. Characteristics and outcomes of surgically ineligible patients with multivessel disease treated with percutaneous coronary intervention. Catheter Cardiovasc Interv 2021; 98:1223-1229. [PMID: 33533551 DOI: 10.1002/ccd.29508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 11/10/2020] [Accepted: 12/29/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVES In this study we evaluated the clinical characteristics and outcomes of surgically ineligible patients with coronary artery disease (CAD) who underwent multivessel percutaneous coronary intervention (PCI). BACKGROUND Patients with multivessel CAD who are surgically ineligible and undergo PCI are not well represented in large trials. METHODS Out of 1,061 consecutive patients who underwent a non-emergent PCI for unprotected left main or multivessel CAD at the University of Virginia Medical Center, 137 patients were determined to be surgically ineligible for coronary artery bypass graft (CABG) surgery by a heart team. The clinical characteristics and reasons for surgical ineligibility were collected. The coronary angiograms were reviewed and the SYNTAX score calculated. The Society of Thoracic Surgeons (STS) score was calculated. Outcomes were determined at 30 days and 1-year. RESULTS The mean age of the cohort was 71 and 59% were women. Hypertension, hyperlipidemia, tobacco abuse, and diabetes were common comorbidities. The average SYNTAX score was 22. The most commonly cited reasons for surgical ineligibility were advanced age, frailty, severe lung disease, ejection fraction ≤ 30% and STS score ≥ 8%. Outcomes at 30 days were excellent and better than those predicted by STS for surgery. Frailty and STS score predicted one-year outcomes. CONCLUSIONS Patients undergoing PCI for multivessel disease who are surgically ineligible have multiple risk factors and comorbidities. Frailty, lung disease, poor left ventricular function, and high STS score represent common reasons for surgical ineligibility. Frailty and the STS score better predict one-year outcomes after PCI compared to the SYNTAX score.
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Affiliation(s)
- Mary C Shields
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Michelle Ouellette
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Nicholas Kiefer
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Luke Kohan
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Angela M Taylor
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Gorav Ailawadi
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
| | - Michael Ragosta
- The Cardiovascular Division and Division of Cardiothoracic Surgery, University of Virginia Health Systems, Charlottesville, Virginia
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Kupó P, Tornyos D, Bálint A, Lukács R, Jánosi A, Komócsi A. Use of drug-eluting stents in elderly patients with acute myocardial infarction: An analysis of the Hungarian Myocardial Infarction Registry. Int J Clin Pract 2021; 75:e13652. [PMID: 32851755 DOI: 10.1111/ijcp.13652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 08/04/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Bare-metal stents (BMS) are frequently implanted in elderly patients instead of drug-eluting stents (DES). We aimed to compare the prognosis of patients treated for myocardial infarction with the two types of stents over the age of 75. METHODS Data of patients registered in the Hungarian Myocardial Infarction Registry, a mandatory nationwide programme for hospitals treating patients with myocardial infarction were processed. From patients included between January 2014 and December 2017 we created two groups according to DES and BMS implantation. The outcome measures included all-cause mortality, the composite of cardiac events (MACE), repeated revascularisation and transfusion. Propensity score matching was used to balance the groups and Cox proportional hazards' models to estimate the risk during the 1st year after the index event. RESULTS From 7383 patients (age: 81.08 ± 4.38 years) 3266 (44.2%) patients received DES. The PS-matched cohort included 5780 cases with balanced characteristics. In the DES group, the mortality (HR 0.66 [0.60-0.72]), MACE (HR 0.66 [0.60-0.72]) and the rate of transfusion (HR 0.84 [0.73-0.97]) were significantly lower. The PS-matched cohort showed a similar trend but with a lower rate of benefits with a 21% reduction of mortality and 23% of MACE. Difference in transfusion did not reach the level of significance. In multivariate models, stent type prevailed as an independent predictor of mortality and but not of transfusion. CONCLUSIONS Based on our analysis of a real-life, high-risk population, implantation of DES seems to be an advantageous strategy for elderly patients.
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Affiliation(s)
- Péter Kupó
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Dániel Tornyos
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Alexandra Bálint
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - Réka Lukács
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
| | - András Jánosi
- Hungarian Myocardial Infarction Registry, Gyorgy Gottsegen Hungarian Institute of Cardiology, Budapest, Hungary
| | - András Komócsi
- Heart Institute, Medical School, University of Pécs, Pécs, Hungary
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Cockburn J, Kemp T, Ludman P, Kinnaird T, Johnson T, Curzen N, Robinson D, Mamas M, de Belder A, Hildick-Smith D. Percutaneous coronary intervention in octogenarians: A risk scoring system to predict 30-day outcomes in the elderly. Catheter Cardiovasc Interv 2020; 98:1300-1307. [PMID: 33283484 DOI: 10.1002/ccd.29406] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/26/2020] [Accepted: 11/15/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Octogenarians are a high-risk group presenting for percutaneous coronary intervention (PCI). We aimed to create a 30-day mortality risk model for octogenarians presenting with both acute coronary syndrome (ACS) and chronic stable angina (CSA), using comprehensive mandatory UK data submissions to the UK National database. BACKGROUND Octogenarians are a high-risk group presenting for percutaneous coronary intervention, and decisions on whether or not to undertake intervention in this cohort can be challenging. The increasing number of octogenarians in the general population means they represent an important high-risk subgroup of patients. METHODS The data group consisted of 425,897 PCI procedures undertaken in the UK between 2008 and 2012 during which time there was comprehensive data linkage to mortality via the Office of National Statistics. Of these procedures, 44,221 (10.4%) were in patients aged ≥80. These comprised the model group. Logistic regression was used to create a predictive score which ultimately consisted of the following weightings: age 80-89 (n = 1); age > 90 (n = 2); unstable angina/non-ST-elevation myocardial infraction (NSTEMI) (n = 1); STEMI (n = 2); creatinine >200 mmol/L (n = 1); preprocedural ventilation (n = 1); left ventricular ejection fraction <30% (n = 1); cardiogenic shock (n = 2). Multiple imputation was used to account for missing data. RESULTS The patient cohort was divided into a derivation (n = 22,072) and a validation dataset (n = 22,071). Receiver operating characteristic analyses were used to derive the area-under-the-curve to assess properties of the score. The scoring system generated an AUC 0.83, (95% CI 0.80-0.85) suggesting high sensitivity and specificity. Scores of 1-4 were associated with good survival but scores ≥5 were associated with an estimated likelihood of death within 30 days of ≥40%. CONCLUSIONS This octogenarian risk score maybe a useful tool to determine the chance of a successful outcome in elderly patients presenting for PCI.
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Affiliation(s)
- James Cockburn
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Tiffany Kemp
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Peter Ludman
- Queen Elizabeth Hospital NHS Trust, Birmingham, UK
| | | | | | - Nick Curzen
- University Hospital Southampton, Southampton, UK
| | - Derek Robinson
- Department of Mathematics, Sussex University, Brighton, UK
| | - Mamas Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Manchester, UK
| | - Adam de Belder
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Rezapour A, Tavakoli N, Akbari S, Hajahmadi M, Ameri H, Mohammadi R, Bagheri Faradonbeh S. Medical therapy versus percutaneous coronary intervention in ischemic heart disease: A cost-effectiveness analysis. Med J Islam Repub Iran 2020; 34:155. [PMID: 33500882 PMCID: PMC7813149 DOI: 10.47176/mjiri.34.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Ischemic heart disease is categorized into two acute and chronic groups, and its treatments include revascularization and medical therapy. The aim of this study is to evaluate the economic burden of medical therapy compared to percutaneous coronary intervention in ischemic heart disease. Methods: This study has been done in two steps. The first was a systematic review and meta-analysis to measure the effectiveness of two interventions and the second step was a cost-effectiveness analysis from the perspective of society. The data analysis included a meta-analysis and the Markov cohort simulation. RewMan v5 and tree age software were utilized. Uncertainties related to the model parameters were evaluated using one-way and two-way sensitivity analyses. Results: Regarding the effectiveness of interventions, the odd ratio of the quality of life in the medical therapy group (CI: 0.76-1.10) was 0.91 times the PCI group (p=0.34). This rate for mortality in medical therapy (CI: 0.52-9.68) was 2.23 times more than the PCI group; this result was not significant (p=0.02). In the cost-effectiveness analysis, the cost-effectiveness threshold was $ 16,482; ICER in increasing the QoL and reduction in the mortality rate was $ 25320.11 and $ 562.6691, respectively. Regarding the sensitivity analysis, the model was not sensitive in changing parameters in a specific domain. Conclusion: According to this study, PCI is more cost-effective than medical therapy in the reduction of mortality rate and in the field of increasing quality of life. MT strategy is more cost-effective than the PCI. This study considers controversies regarding the most appropriate treatment for patients with ischemic heart disease that is helpful for health policymakers, cardiologists and health managers.
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Affiliation(s)
- Aziz Rezapour
- Health Management and Economics Research Center, Iran University of Medical
Sciences, Tehran, Iran
| | - Nader Tavakoli
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran,
Iran
| | - Sadaf Akbari
- Trauma and Injury Research Center, Iran University of Medical Sciences, Tehran,
Iran
| | - Marjan Hajahmadi
- Department of Cardiology, Hazrat Rasoul Medical and Research Center, Iran
University of Medical Sciences, Tehran, Iran
| | - Hosein Ameri
- Department of Healthcare Management, School of Public Health, Shahid Sadoughi
University of Medical Sciences, Yazd, Iran
| | - Reza Mohammadi
- Firouzabadi Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Saeed Bagheri Faradonbeh
- Health Management and Economics Research Center, Iran University of Medical
Sciences, Tehran, Iran
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Lal S, Gray A, Kim E, Bunton RW, Davis P, Galvin IF, Williams MJ. Frailty in Elderly Patients Undergoing Cardiac Surgery Increases Hospital Stay and 12-Month Readmission Rate. Heart Lung Circ 2020; 29:1187-1194. [DOI: 10.1016/j.hlc.2019.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 07/16/2019] [Accepted: 10/13/2019] [Indexed: 01/09/2023]
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Li ZZ, Wu XY, Tao Y, Wang S, Yin CQ, Gao YL, Cheng YT, Li Z, Ma CS. Revascularization versus drug therapy for coronary artery disease in patients aged over 80 years: a real-world study. Cardiovasc Diagn Ther 2020; 10:512-519. [PMID: 32695630 DOI: 10.21037/cdt-20-185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Revascularization for the treatment of coronary artery disease (CAD) is advancing rapidly and is used increasingly in old patients. This study aimed to compare the efficacy and safety of revascularization with drug therapy in CAD patients aged over 80 years at a real-world clinical setting. Methods A total of 501 CAD patients aged over 80 years were consecutively enrolled from January 2011 to January 2016 in Anzhen Hospital (Beijing, China), Capital Medical University. The patients were treated with percutaneous coronary intervention (PCI) (n=283), coronary artery bypass grafting (CABG) (n=106), or drug therapy (n=112). All-cause mortality, cardiovascular-related mortality, readmission rate, and Seattle Angina Questionnaire (SAQ) score were compared between the three treatment methods. Results A total of 411 patients (82.04%) were followed with a median duration of 25 months. All-cause mortality and cardiovascular-related mortality in the drug therapy group were significantly higher than the PCI and CABG groups (both P<0.05). Readmission rate for cardiovascular events in the CABG group was significantly lower than the PCI and drug therapy groups (both P<0.05). Scores of physical limitation, angina frequency, treatment satisfaction, and disease perception of the SAQ in the PCI and CABG groups were significantly higher than the drug therapy group (both P<0.05). Scores of angina stability did not differ significant between the three groups (P=0.127). Conclusions Revascularization is superior to drug therapy in efficacy and safety in the treatment of oldest-old patients with CAD.
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Affiliation(s)
- Zhi-Zhong Li
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiang-Yu Wu
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Tao
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Su Wang
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Cheng-Qian Yin
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu-Long Gao
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yu-Tong Cheng
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhao Li
- Department of Cardiology Ward 5, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Lemaire A, Soto C, Salgueiro L, Ikegami H, Russo MJ, Lee LY. The impact of age on outcomes of coronary artery bypass grafting. J Cardiothorac Surg 2020; 15:158. [PMID: 32611349 PMCID: PMC7328264 DOI: 10.1186/s13019-020-01201-3] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE As the population ages, increasing number of older patients are undergoing adult cardiac surgery. The purpose of the study is to assess the impact of age on postoperative outcomes in patients that undergo coronary artery bypass grafting (CABG). METHODS Patients that are ≥70 years old who underwent CABG were selected from the Nationwide/National Inpatient Sample from 2010 to 2015 using ICD-9-CM diagnosis and procedure codes. The patients who were 70-79 years old were compared to patients aged 80-89 years old to determine if the age difference of the patients had an impact on surgical outcomes. In addition, a secondary endpoint is to compare surgical outcomes between the 2 genders of the patients 80-89 years old. The rates of postoperative complications, and mortality were compared. RESULTS A total of 67,568 patients were identified who were ≥ 70 years old and underwent CABG. Compared to the Septuagenarians, the Octogenarians were more likely to develop cardiac complications (OR [odds ratio] =1.20, 95% CI [confidence interval] 1.12-1.23. They were also more likely to develop renal complications (P < 0001), and respiratory complications (P < 0001). The Octogenarians were also more likely to bleed postoperatively (P < 0.0001) and have a higher mortality (P < 0001). Furthermore, the female Octogenarians had a higher mortality (OR 1.25 95% CI 1.07-1.46) compared to males in the same age group. CONCLUSIONS The patients who were ≥ 80-89 years old had worse postoperative outcomes. The Octogenarians who were females had a higher mortality compared to their male counterparts.
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Affiliation(s)
- Anthony Lemaire
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA.
| | - Cassandra Soto
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA
| | - Lauren Salgueiro
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA
| | - Hirohisa Ikegami
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA
| | - Mark J Russo
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA
| | - Leonard Y Lee
- Division of Cardiothoracic Surgery, Department of Surgery, RUTGERS-Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, New Jersey, 08903, USA
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Non-ST elevation acute coronary syndrome in patients aged 80 years or older in Vietnam: An observational study. PLoS One 2020; 15:e0233272. [PMID: 32542011 PMCID: PMC7295222 DOI: 10.1371/journal.pone.0233272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 05/01/2020] [Indexed: 12/02/2022] Open
Abstract
Background There is limited evidence of non-ST elevation acute coronary syndrome (NSTE-ACS) in patients aged 80 or older in Vietnam. Aim To describe the clinical characteristics of patients aged≥80 with NSTE-ACS in Vietnam, and to examine the effect of percutaneous coronary intervention (PCI) on adverse outcomes. Methods Consecutive patients aged ≥80 with a diagnosis of NSTE-ACS admitted to two tertiary hospitals in Vietnam from 12/2018 to 06/2019 were recruited. The major outcomes were: (1) the composite of all-cause mortality, recurrent myocardial infarction and stroke, (2) re-admission rate during 3 months. Cox proportional-hazards regressions were conducted to examine the impact of PCI on the study outcomes, with results presented as hazard ratios (HR) and 95% confidence intervals (CI). Results There were 120 participants, mean age 84.8 ± 3.8, 50% were female. Angiography and PCI were performed in 42 participants (35.0%). Most of the participants had multimorbidity and multiple coronary vessel disease. Compared to participants who did not receive PCI, participants who received PCI had significantly lower rates of adverse events during hospitalisation and during 3 months of follow up. Cox proportional hazards models adjusted to age and GRACE score show that PCI was significantly associated with reduced the composite outcome of all-cause mortality, recurrent myocardial infarction and stroke during 3 months follow-up (adjusted HR 0.32, 95%CI 0.12–0.86). PCI was also associated with reduced re-admission. Conclusions The rate of PCI was low in the very elderly patients with NSTE-ACS in this study, although PCI was significantly associated with reduced adverse outcomes.
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Clinical efficacy of different treatments and their impacts on the quality of life of octogenarians with coronary artery disease. Chin Med J (Engl) 2020; 132:2657-2663. [PMID: 31725445 PMCID: PMC6940100 DOI: 10.1097/cm9.0000000000000504] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Coronary artery disease (CAD) in octogenarians (age of ≥80 years) has a high risk of mortality and high medical expenses. Research shows that the prevalence of CAD is higher among octogenarians than that among younger people, but few such patients undergo percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). This study aimed to evaluate different treatments with respect to their clinical effects and impacts on quality of life of octogenarians with CAD. Methods: Data of 519 octogenarians with CAD consecutively treated at Beijing Anzhen Hospital, Capital Medical University (Beijing, China) from January 2010 to January 2016 were collected in this study. The patients were categorized into three groups based on the treatments they received: the PCI group (n = 292), CABG group (n = 110), and medical treatment group (n = 117). The followings were recorded during follow-up: clinical data, death (all-cause and cardiovascular-related), re-hospitalization time, Seattle Angina Questionnaire (SAQ) score, and occurrence of hemorrhagic events (cerebral bleeding, gastrointestinal bleeding, and dermal ecchymosis). Results: The median follow-up duration was 25.0 (25th, 75th percentile: 17.0, 55.5) months among 417 patients. The all-cause death rates (28.2% vs. 12.0% and 14.6%, respectively) and cardiovascular-related death rates (15.4% vs. 3.8% and 6.4%, respectively) were significantly higher in the medical treatment group than those in the PCI group and CABG group (all P < 0.05). The re-hospitalization rate for cardiovascular events was significantly lower in the CABG group than those in the PCI group and medical treatment group (3.8% vs. 12.8% and 14.9%, respectively) (χ2 = 8.238, P = 0.018). The SAQ scores of physical limitation, angina frequency, treatment satisfaction, and disease perception were significantly higher in the PCI group and CABG group than those in the medical treatment group (all P < 0.05). No significant difference in the angina stability score was observed among the three groups (F = 3.179, P = 0.204). Conclusion: PCI and CABG result in reduced mortality and better quality of life in octogenarians with CAD.
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Sanoussi H, Bitton N, Kourireche N, Bernasconi F, Tounsi A, Bellemain-Appaix A, Jacq L. [Interests and limitations of percutaneous coronary intervention strategy in nonagenarian patients: A single center experience]. Ann Cardiol Angeiol (Paris) 2020; 69:1-6. [PMID: 32145882 DOI: 10.1016/j.ancard.2020.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 01/05/2020] [Indexed: 10/24/2022]
Abstract
AIM To expose our center results in the angioplasty in nonagenarians and to evaluate its effectiveness but also the MACEs and the mortality in the short and long term. METHODS A retrospective study of 98 patients admitted to the Antibes hospital center from November 2013 to September 2018. RESULTS The median age was 91.8 [90.8-93.4]. 52.6% was male. 9.7% of the patients had a polyvascular site. 50.6% of patients had moderate renal failure. The radial approach was used in 88.4% of cases. 21.6% of patients had tri-truncal lesions, while 46.4% were monotruncular, LAD artery was the culprit artery in 67% of cases. One stent per lesion was used in the majority of cases. Our successful rate was 90%. After angioplasty, 96% of the patients underwent double antiaggregation platelet therapy, 74.4% under clopidogrel. The presence of arrhythmias before angioplasty, the femoral approach, the coronary dissection and cardiogenic shock after angioplasty were predictors of short- and long-term mortality. Diabetes, history of myocardial infarction, impaired left ventricular ejection fraction, calcified coronary lesions, occurrence of arrhythmias or signs of heart failure on post-procedure were predictors of MACE occurrence. CONCLUSIONS This study demonstrates that angioplasty in selected population of nonagenarians is perfectly feasible with a good risk/benefit ratio and specifies the different predictors of MACE, both short- and long-term mortality.
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Affiliation(s)
- H Sanoussi
- Service de cardiologie, centre hospitalier Antibes Juan-Les-Pins, groupe hospitalier Sophia-Antipolis-Vallée-du-Var, 107, avenue de Nice, 06606 Antibes cedex, France.
| | - N Bitton
- Service de cardiologie, centre hospitalier Antibes Juan-Les-Pins, groupe hospitalier Sophia-Antipolis-Vallée-du-Var, 107, avenue de Nice, 06606 Antibes cedex, France
| | - N Kourireche
- Service de cardiologie, centre hospitalier Antibes Juan-Les-Pins, groupe hospitalier Sophia-Antipolis-Vallée-du-Var, 107, avenue de Nice, 06606 Antibes cedex, France
| | - F Bernasconi
- Service de cardiologie, centre hospitalier Antibes Juan-Les-Pins, groupe hospitalier Sophia-Antipolis-Vallée-du-Var, 107, avenue de Nice, 06606 Antibes cedex, France
| | - A Tounsi
- Service de cardiologie, centre hospitalier Antibes Juan-Les-Pins, groupe hospitalier Sophia-Antipolis-Vallée-du-Var, 107, avenue de Nice, 06606 Antibes cedex, France
| | - A Bellemain-Appaix
- Service de cardiologie, centre hospitalier Antibes Juan-Les-Pins, groupe hospitalier Sophia-Antipolis-Vallée-du-Var, 107, avenue de Nice, 06606 Antibes cedex, France
| | - L Jacq
- Service de cardiologie, centre hospitalier Antibes Juan-Les-Pins, groupe hospitalier Sophia-Antipolis-Vallée-du-Var, 107, avenue de Nice, 06606 Antibes cedex, France
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Uryuzhnikov VV, Zhbanov IV, Galimov NM, Kiladze IZ, Martirosyan AK, Revishvili GA, Shabalkin BV. [Features of surgical treatment of advanced age patients with coronary artery disease]. Khirurgiia (Mosk) 2020:5-12. [PMID: 32105250 DOI: 10.17116/hirurgia20200215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To optimize surgical treatment of patients aged over 70 years with coronary artery disease. MATERIAL AND METHODS There were 398 patients aged over 70 years with coronary artery disease for the period 2006-2017. All patients were divided into 3 groups: group 1 - on-pump coronary artery bypass grafting (CABG) with cardiac arrest; group 2 - on-pump beating heart CABG, group 3 - off-pump CABG. RESULTS On-pump beating heart CABG in patients over 70 years old is followed by reduced incidence of perioperative complications including acute heart failure, acute respiratory failure, neurological complications, reduced length of ICU- and hospital-stay compared with on-pump CABG and cardiac arrest. However, off-pump CABG is optimal in advanced age patients because this approach reduces duration of surgery, intraoperative blood loss, incidence of acute heart failure, neurological complications and cardiac rhythm disturbances. Postoperative annual and 5-year survival rates were 98.1 and 84.2%, respectively. CONCLUSION Off-pump CABG is preferable in advanced age patients. Surgical treatment of these patients is characterized by high clinical efficacy in long-term period after surgery.
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Affiliation(s)
- V V Uryuzhnikov
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - I V Zhbanov
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - N M Galimov
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - I Z Kiladze
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - A K Martirosyan
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - G A Revishvili
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
| | - B V Shabalkin
- Petrovsky Russian Research Center of Surgery, Moscow, Russia
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Affiliation(s)
- Sonali Kumar
- Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Michael McDaniel
- Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Habib Samady
- Division of Cardiology Department of Medicine Emory University Atlanta GA
| | - Farshad Forouzandeh
- Division of Cardiology Department of Medicine Emory University Atlanta GA.,Division of Cardiology Department of Medicine Case Western Reserve University Cleveland OH
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Sajobi TT, Wang M, Awosoga O, Santana M, Southern D, Liang Z, Galbraith D, Wilton SB, Quan H, Graham MM, James MT, Ghali WA, Knudtson ML, Norris C. Trajectories of Health-Related Quality of Life in Coronary Artery Disease. Circ Cardiovasc Qual Outcomes 2019; 11:e003661. [PMID: 29545392 DOI: 10.1161/circoutcomes.117.003661] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 01/10/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Health-related quality of life (HRQOL) assessment is an important health outcome for measuring the efficacy of treatments and interventions for coronary artery disease (CAD). HRQOL is known to improve over the first year after interventions for CAD, but there is limited knowledge of the changes in HRQOL beyond 1 year. We investigated heterogeneity in long-term trajectories of HRQOL in patients with CAD. METHODS AND RESULTS Data were obtained from 6226 patients identified from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease with at least 1-vessel CAD who underwent their first catheterization between 2006 and 2009. HRQOL was assessed using the Seattle Angina Questionnaire, a 19-item disease-specific measure of HRQOL for patients with CAD. Group-based trajectory analysis was used to identify various subgroups of Seattle Angina Questionnaire trajectories over time while adjusting for missing data through a longitudinal multiple imputation model. Multinomial logistic regression was used to identify the predictors of differences among the identified subgroups. Our analysis revealed significant improvements in HRQOL across all the 5 domains of Seattle Angina Questionnaire overtime for the whole data. Multitrajectory analyses revealed 4 HRQOL trajectory subgroups including high (25.1%), largely increased (32.3%), largely decreased (25.0%), and low (17.6%) trajectories. Age, sex, body mass index, diabetes mellitus, previous history of myocardial infarction, smoking, depression, anxiety, type of treatment received, and perceived social support were significant predictors of differences among these trajectory subgroups. CONCLUSIONS This study highlights variations in longitudinal trajectories of HRQOL in patients with CAD. Despite overall improvements in HRQOL, about a quarter of our cohort experienced a significant decline in their HRQOL over the 5-year period. Understanding these HRQOL trajectories may help personalize prognostic information, identify patients and HRQOL domains on which clinical interventions are most beneficial, and support treatment decisions for patients with CAD.
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Affiliation(s)
- Tolulope T Sajobi
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada.
| | - Meng Wang
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Oluwagbohunmi Awosoga
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Maria Santana
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Danielle Southern
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Zhiying Liang
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Diane Galbraith
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Stephen B Wilton
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Hude Quan
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Michelle M Graham
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Matthew T James
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - William A Ghali
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Merrill L Knudtson
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
| | - Colleen Norris
- From the Department of Community Health Sciences, O'Brien Institute for Public Health (T.T.S., M.W., M.S., D.S., Z.L., D.G., H.Q., M.T.J., W.A.G.), Department of Cardiac Sciences (D.G., S.B.W., M.L.K.), and Department of Medicine (S.B.W., M.T.J., W.A.G., M.L.K.), University of Calgary, Canada; Faculty of Health Sciences, University of Lethbridge, Canada (O.A.); and Faculty of Medicine & Dentistry (M.M.G.) and Faculty of Nursing (C.N.), University of Alberta, Edmonton, Canada
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Flores‐Umanzor EJ, Vázquez S, Cepas‐Guillen P, Ivey‐Miranda J, Caldentey G, Jimenez‐Britez G, Regueiro A, Freixa X, Andrea R, Ferreira‐González I, Sabaté M, Martin‐Yuste V. Impact of revascularization versus medical therapy alone for chronic total occlusion management in older patients. Catheter Cardiovasc Interv 2019; 94:527-535. [DOI: 10.1002/ccd.28163] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 02/09/2019] [Indexed: 01/22/2023]
Affiliation(s)
| | - Sara Vázquez
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Pedro Cepas‐Guillen
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Juan Ivey‐Miranda
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Guillem Caldentey
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Gustavo Jimenez‐Britez
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Ander Regueiro
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Xavier Freixa
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Rut Andrea
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Ignacio Ferreira‐González
- Cardiology DepartmentVall d'hebron Hospital, Barcelona, and CIBER de Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
| | - Manel Sabaté
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
| | - Victoria Martin‐Yuste
- Cardiology DepartmentCardiovascular Institute, Hospital Clínic, University of Barcelona Barcelona Spain
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Comparing the effectiveness of revascularization interventions with medical therapy in patients with ischemic cardiomyopathy: A systematic review and meta-analysis. Med J Islam Repub Iran 2019; 32:127. [PMID: 30815422 PMCID: PMC6387802 DOI: 10.14196/mjiri.32.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Indexed: 12/03/2022] Open
Abstract
Background: Determining the effectiveness of cardiovascular interventions plays an important role in reimbursement decisions, health care pricing, and providing clinical guidance on the use of existing clinical technologies. This study aimed to review and analyze the effectiveness of revascularization interventions (CABG and PCI) compared to medical therapy in patients with ischemic cardiomyopathy.
Methods: Different databases were searched up to December 2017. The articles were selected based on inclusion and exclusion criteria. Quality of all studies was evaluated by Jadad score and relevant checklists. The I2 test was used to test heterogeneity. Also, to integrate the results of similar studies, meta-analysis was done using STATA software.
Results: A total of 18 studies were included. Based on the random effects model, the overall results of comparing the effectiveness of revascularization interventions with medical therapy were as follow: 38.94 [95% CI: 26.95-50.94, p<0.001, I2 = 99.6%, p<0.001], [75.31, 95% CI: 74.06-76.57, p<0.001, I2= 88.8, p<0.001], and 75.76 [95% CI: 71.99-79.53, p<0.001, I2= 99.2, p<0.001] for cardiac mortality rate, quality of life, and 5-year survival, respectively. Also, in patient satisfaction index, revascularization interventions were shown to be more effective than medical therapy.
Conclusion: This study showed that revascularization interventions in all studied indices were more effective than medical therapy. Also, between revascularization interventions, PCI was more effective in cardiovascular mortality and 5-year survival than CABG in terms of quality of life. Moreover, CABG was more effective than PCI. In patient satisfaction index, the results of the 2 included studies were contradictory.
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Dedicator of cytokinesis 2 silencing therapy inhibits neointima formation and improves blood flow in rat vein grafts. J Mol Cell Cardiol 2019; 128:134-144. [DOI: 10.1016/j.yjmcc.2019.01.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 01/02/2019] [Accepted: 01/31/2019] [Indexed: 01/01/2023]
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Mason NR, Sox HC, Whitlock EP. A Patient-Centered Approach to Comparative Effectiveness Research Focused on Older Adults: Lessons From the Patient-Centered Outcomes Research Institute. J Am Geriatr Soc 2018; 67:21-28. [PMID: 30586155 PMCID: PMC7379603 DOI: 10.1111/jgs.15655] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 09/13/2018] [Accepted: 09/15/2018] [Indexed: 11/28/2022]
Abstract
The mission of the Patient-Centered Outcomes Research Institute (PCORI) is to fund the production of high-quality evidence that will enable patients and clinicians to make informed, personalized healthcare decisions. Since 2012, the PCORI has invested $177 million in patient-centered comparative effectiveness research (CER) that specifically targets the health needs of older adults, with additional relevant studies in its broader portfolio. Developing the PCORI's research portfolio has provided us with significant insights into what factors to consider when conducting CER in older adult populations. When comparing the net benefit of two or more interventions for older adults, investigators should consider the following: absolute risk difference, competing risks, life expectancy, the difference between chronologic and physiologic age, the importance of patient preferences, and other potential drivers of variable treatment effects. Investigators should also engage older adults and their caregivers as partners throughout the research process. Their input helps to identify key outcomes of interest and insights about the conduct of the research. As the PCORI continues to support research that addresses the healthcare decisions of the rapidly growing older adult population, it needs to partner with patients and researchers to identify the most important questions to address. J Am Geriatr Soc 67:21-28, 2019.
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Affiliation(s)
- Noah R Mason
- Patient-Centered Outcomes Research Institute, Washington, District of Columbia
| | - Harold C Sox
- Patient-Centered Outcomes Research Institute, Washington, District of Columbia
| | - Evelyn P Whitlock
- Patient-Centered Outcomes Research Institute, Washington, District of Columbia
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Halna du Fretay X, Schnebert B, Genée O, Boyo M. [Which elderly with stable angina should be referred for cardiac surgery?]. Ann Cardiol Angeiol (Paris) 2018; 67:429-438. [PMID: 30342829 DOI: 10.1016/j.ancard.2018.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The choice of revascularization of coronary patients, if it is well codified in the general population, remains in the elderly subject a daily dilemma for the clinician. We report 4 clinical cases (80 years and over) elective for coronary artery bypass or percutaneous coronary transluminal angioplasty (PTCA). No randomized studies dedicated to this population are available. Nevertheless, according to the registries, surgery versus PTCA has a superior benefit in the medium and long term, despite higher mortality and stroke. The coronary lesions in this population are actually more complex, usually leading to surgery compared to a younger population. However, the choice of the revascularization method is difficult depending on the co-morbidities and the higher surgical risk. What must be taken into account here are the cognitive abilities, the risk of cognitive decline, the frailty of the patient (correlated with mortality), frailty being a subjective data given without a consensually recognized scoring system. The indication of the revascularization method should include mortality risks as well as morbidity, in particular the potential risk of deterioration of the general condition and autonomy of patients, particularly the elderly. Randomized studies dedicated to this population, taking into account mortality and morbidity, and in particular the "concept of frailty", would make it possible to describe the specificities of aging subjects in recommendations and good practices.
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Affiliation(s)
- X Halna du Fretay
- Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France; Centre hospitalier universitaire Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | - B Schnebert
- Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France
| | - O Genée
- Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France
| | - M Boyo
- Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France
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Mandawat A, Mandawat A. Chronological Age Is Just a Number When it Comes to Percutaneous Coronary Intervention. JACC Cardiovasc Interv 2018; 11:1883-1884. [DOI: 10.1016/j.jcin.2018.07.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
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Chen X, Barywani SB, Sigurjonsdottir R, Fu M. Improved short and long term survival associated with percutaneous coronary intervention in the elderly patients with acute coronary syndrome. BMC Geriatr 2018; 18:137. [PMID: 29898676 PMCID: PMC6001043 DOI: 10.1186/s12877-018-0818-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 05/16/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) are increasingly used in daily clinical practice in elderly patients with acute coronary syndrome (ACS) despite limited evidence. The purpose of this study was to assess the impact of PCI on short and long term survivals in a large cohort of elderly patients with ACS from a "real world". METHODS We enrolled 491 patients aged ≥70 years admitted to our institution with ACS from 2006 to 2012. Effect of PCI on short and long term survival was evaluated in both overall and a propensity score-matched cohort. RESULTS The mean age of the overall cohort is 83 ± 6 years. Among them, 285 were treated with PCI, whereas 206 were not. Patients treated with PCI were younger (82 ± 5 vs. 85 ± 6), more males (67% vs. 46%), with lower heart rate (77 ± 22 vs. 84 ± 21), higher eGFR (58 ± 20 vs. 47 ± 23), and less with heart failure (29% vs. 15%) (all p < 0.001). In both overall and propensity-matched population, improved survival was associated with PCI-treatment at 1 and 3 years (p < 0.001 for all comparisons). Furthermore, by using multivariate Cox proportional-hazards regression model following factors were identified as independent predictors of 3-year all-cause mortality: age (HR 1.08, 95% CI 1.00-1.16), heart rate (HR 1.02, 95% CI 1.01-1.03), eGFR (HR 3.07, 95% CI 1.63-5.77), malignancy (HR 2.03, 95% CI 1.27-4.57), prior CABG (HR 2.033, 95% CI 1.27-4.57), medication with statin (HR 0.40, 95% CI 0.19-0.86) in PCI group, whereas age (HR 1.08, 95% CI 1.03-1.13), heart rate (HR 1.01, 95% CI 1.01-1.02), hypertension (HR 1.87, 95% CI 1.01-3.49) and using of ACEI/ARB (HR 0.46, 95% CI 0.28-0.76) in non-PCI group. CONCLUSIONS In elderly ACS patients, PCI-treatment was associated with improved 1 and 3-year survival and PCI-treated patients had different prognostic profile compared to those without PCI treatment.
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Affiliation(s)
- Xiaojing Chen
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China. .,Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, 416 50, Göteborg, SE, Sweden.
| | - Salim Bary Barywani
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Runa Sigurjonsdottir
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Michael Fu
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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