BackgroundElderly, frail patients are often excluded from clinical trials so there is lack of data regarding optimal management when they present with symptomatic coronary artery disease (CAD).ObjectiveThe aim of this observational study was to evaluate an unselected elderly population with CAD for the occurrence of frailty, and its association with quality of life (QoL) and clinical outcomes.MethodsConsecutive patients aged ≥80 years presenting with CAD were prospectively assessed for frailty (Fried frailty phenotype (FFP), Edmonton frailty scale (EFS)), QoL (Short form survey (SF-12)) and comorbidity (Charlson Comorbidity Index (CCI)). Patients were re-assessed at 4 months to determine any change in frailty and QoL status as well as the clinical outcome.ResultsOne hundred fifty consecutive patients with symptomatic CAD were recruited in the study. The mean age was 83.7±3.2 years, 99 (66.0%) were men. The clinical presentation was stable angina in 68 (45.3%), the remainder admitted with an acute coronary syndrome including 21 (14.0%) with ST-elevation myocardial infarction. Frailty was present in 28% and 26% by FFP and EFS, respectively, and was associated with a significantly higher CCI (7.5±2.4 in frail, 6.2±2.2 in prefrail, 5.9±1.6 in those without frailty, p=0.005). FFP was significantly related to the physical composite score for QoL, while EFS was significantly related to the mental composite score for QoL (p=0.003). Treatment was determined by the cardiologist: percutaneous coronary intervention in 51 (34%), coronary artery bypass graft surgery in 15 (10%) and medical therapy in 84 (56%). At 4 months, 14 (9.3%) had died. Frail participants had the lowest survival. Cardiovascular symptom status and the mental composite score of QoL significantly improved (52.7±11.5 at baseline vs 55.1±10.6 at follow-up, p=0.04). However, overall frailty status did not significantly change, nor the physical health composite score of QoL (37.2±11.0 at baseline vs 38.5±11.3 at follow-up, p=0.27).ConclusionsIn patients referred to hospital with CAD, frailty is associated with impaired QoL and a high coexistence of comorbidities. Following cardiac treatment, patients had improvement in cardiovascular symptoms and mental component of QoL.
calculated using DerSimonian and Laird method for the overall outcome of major bleeding. A subgroup analysis was conducted for major bleeding according to the method of glycoprotein IIb/IIIa (GPI) administration in each trial (i.e., planned or bailout). Meta-regression analysis was conducted for the outcome of major bleeding with the dose of UFH in the control arm.RESULTS A total of 20 trials were included. The incidence of major bleeding was 3.2% in the bivalirudin arm compared with 4.6% in the UFH arm (RR 0.65, 95% CI 0.54-0.79, p<0.0001, I2¼63%). In the subgroup analysis by the method of GPI use, the incidence of major bleeding was significantly lower in trials using planned GPI in the UFH arm only (RR 0.55, 95% CI 0.49-0.62, p<0.0001, I2¼0%) but not for trials using either planned or bailout GPI equally in both arms (RR 1.08, 95% CI 0.89-1.30, p¼0.09, I2¼23%; and RR 0.8, 95% CI 0.62-1.03, p¼0.45, I2¼0%; respectively), pinteraction <0.0001 (Figure). Meta-regression was significant when the use of GPI was equal balanced in both arms (i.e., whether planned or bail-out in both arms) (p¼0.012).CONCLUSION Both the method of GPI administration and the dose of unfractionated heparin influence the major bleeding benefit observed bivalirudin in patients undergoing PCI.CONCLUSION Duration of DAPT after coronary stenting with 2nd generation DES did not affect POCO and thrombotic events in CKD B90
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