Acute Coronary Syndrome in the Older Patient

García‐Blas, Sergio; Cordero, Alberto; Díez‐Villanueva, Pablo; Martinez-Avial, Maria; Ayesta, Ana; Arizá-Solé, Albert; Mateus-Porta, Gemma; Martínez‐Sellés, Manuel; Escribano, David; Gabaldon-Perez, A; Bodı́, Vicente; Bonanad, Clara

doi:10.3390/jcm10184132

Cited by 26 publications

(19 citation statements)

References 115 publications

(158 reference statements)

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“…Aging is an important risk factor for CAD 39,40 and CAD is one of the leading causes of morbidity and the single most common cause of death. [40][41][42][43] CAD morbidity is higher in persons with cancer than in the general population. 44 CAD and cancer share numerous risk factors and cancer patients carry a higher prevalence of cardiovascular risk factors than cancer-free controls.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Adverse Outcomes in Healthy Aging Adults: Coronary Artery Disease, Lower Educational Status and Higher P-Selectin Levels

Batko-Szwaczka¹,

Francuz²,

Kosowska³

et al. 2022

CIA

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Background Societal aging – as a global demographic phenomenon – shows no indication of abating. As a result, the problem of age-associated disability and related long-term care is emerging as a major public health challenge. It is important that methods for identifying older adults at risk of adverse outcomes are implemented early. Methods The study group consisted of 145 individuals, 44.1% women, who were randomized from community-dwelling 60–74-year-old adults. A comprehensive geriatric assessment was supplemented with Fried frailty phenotype evaluation and blood tests (including adhesion molecules, matrix metalloproteinases and neurotrophic factors). A follow-up by phone call was made for at least 3 years after the initial examination. Composite endpoint (CE) included falls, hospitalization, institutionalization and death. Results Mean study group age was 66.5 ± 4.1 years ( ) and mean number of diseases was 3.7 ± 2.2. Functional status of the subjects was good, as indicated by high Barthel Index scores of 99.1 ± 2.4, MMSE scores of 29.0 ±1.5 and no frailty case. During a three-year follow-up, 71 participants (49.0%) experienced any CE-events. The Wilcoxon-Gehan test indicates that a higher probability of three-year CE completion was associated with an age >65 years (P = 0.006), coronary artery disease (CAD) (P = 0.008), 6-Minute Walk Test <432 m (P = 0.034), serum glucose >120 mg/dL (P = 0.047), serum cortisol >10 μg/dL (P = 0.011), leptin ≥15 ng/mL (P = 0.018), P-selectin ≥23 ng/mL (P = 0.006) and GDNF ≥20 pg/mL (P = 0.004). CAD (OR = 3.64, 95% CI = 1.53−8.69, P = 0.004), educational status (OR = 0.87, 95% CI = 0.77−0.98, P = 0.022) and P-selectin levels (OR = 1.07, 95% CI = 1.02−1.13, P = 0.013) were independent measures predicting three-year CE occurrence in multivariate logistic regression analysis adjusted for clinical and functional measures, and blood tests. Conclusion Coronary artery disease, poorer lower educational status and higher P-selectin levels were predictive of adverse outcomes in the community-dwelling healthy-aging early-old adults during three-year follow-up.

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Section: Discussionmentioning

confidence: 99%

Predictors of Adverse Outcomes in Healthy Aging Adults: Coronary Artery Disease, Lower Educational Status and Higher P-Selectin Levels

Batko-Szwaczka¹,

Francuz²,

Kosowska³

et al. 2022

CIA

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“…Almost a third of patients admitted for ACS and two-thirds of those dying from ACS are >75 years old (3,4). Multi-comorbidities, complicated coronary artery lesions, and high prevalence of frailty in the oldest-old have increased the risk of re-infarcted, bleeding complications, and mortality when compared to younger patients (5)(6)(7).…”

Section: Introductionmentioning

confidence: 99%

Geriatric nutritional risk index predicts all-cause mortality in the oldest-old patients with acute coronary syndrome: A 10-year cohort study

Liu

Shen²,

Hou³

et al. 2023

Front. Nutr.

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Background and objectiveNutritional status assessment in acute coronary syndrome (ACS) patients has been neglected for a long time. The geriatric nutritional risk index (GNRI) is a sensitive indicator for assessing the nutritional status of the elderly. This study aims to explore the association between GNRI and all-cause mortality in the oldest-old patients with ACS.MethodsThe patients who met the inclusion criteria were consecutively enrolled from January 2006 to December 2012. Clinical data were collected on admission, and all subjects were followed after being discharged. The nutritional status was evaluated using GNRI. The relationship between GNRI and all-cause mortality was assessed by using different analyses.ResultsA total of 662 patients with a mean age of 81.87 ± 2.14 years old were included in our study, and followed (median: 63 months, IQR 51–71). Patients whose GNRI ≤ 98 were reported as at risk of malnutrition (31.11%, n = 206). In multivariable analysis, we found that for each SD increase in GNRI, the risk of all-cause mortality lowered by 23%, and the HR for GNRI ≤ 98 was 1.39 (95% CI 1.04–1.86). After stratifying patients into three groups by tertiles of GNRI, we found that the HRs for tertile 2 and tertile 3 were 1.49 (95% CI 1.02–2.19) and 1.74 (95% CI 1.22–2.50), respectively. The trend test revealed a dose–response relationship between GNRI and all-cause mortality in the oldest-old with ACS. Lastly, in subgroup analyses, we found a reliable association between GNRI and all-cause mortality.ConclusionMalnutrition is common in the oldest-old patients with ACS, and GNRI could predict their long-term all-cause mortality in a dose-dependent manner. GNRI may be a prospective index for risk-stratification and secondary-prevention in the oldest-old patients with ACS.

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“…Coronary artery disease (CAD) is the most common cause of death worldwide and is a leading cause of mortality and morbidity in the elderly 1‐4 . The population all around the world is aging, in part thanks to the progress made in medical science.…”

Section: Introductionmentioning

confidence: 99%

“…Coronary artery disease (CAD) is the most common cause of death worldwide and is a leading cause of mortality and morbidity in the elderly. 1 , 2 , 3 , 4 The population all around the world is aging, in part thanks to the progress made in medical science. The number of elderly patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) has also increased in recent years 5 , 6 , 7 and is expected to grow even further.…”

Section: Introductionmentioning

confidence: 99%

Prognosis of PCI in AMI setting in the elderly population: Outcomes from the multicenter prospective e‐ULTIMASTER registry

Saada

Kobo

Polad

et al. 2022

Clinical Cardiology

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Background: Elderly patients with ST-elevation myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI) are usually excluded from major trials.Hyopthesis: This study sought to assess 1-year clinical outcomes following PCI with a drug-eluting stent in patients older than 80 years old with STEMI. Methods:The large all-comer, multicontinental e-ULTIMASTER registry included 7507 patients with STEMI who underwent PCI using the Ultimaster stent. The primary clinical endpoint was 1-year target lesion failure, a composite of cardiac death (CD), target vessel-related myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR).Results: There were 457 (6.1%) patients in the elderly group (≥80 years old) that were compared to 7050 (93.9%) patients <80 years. The elderly patients included more female patients and had significantly more comorbidities and had more complex coronary anatomy. The primary endpoint occurred in 7.2% of the elderly, compared to 3.1% of the younger group (p < .001). All-cause mortality was significantly higher among the elderly group compared to the younger group (10.1% vs. 2.3%, p < .0001), as well as CD (6.1% vs. 1.6%, p < .0001), but not TV-MI (1.1% vs. 0.7%, p = .34) or CD-TLR (1.1% vs. 1.4%, p = .63). Conclusion:Elderly patients with STEMI presentation had a higher incidence of the composite endpoint than younger patients. All-cause and CD were higher for elderly patients compared to patients younger than 80 years old. However, there was no

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Acute Coronary Syndrome in the Older Patient

Cited by 26 publications

References 115 publications

Predictors of Adverse Outcomes in Healthy Aging Adults: Coronary Artery Disease, Lower Educational Status and Higher P-Selectin Levels

Predictors of Adverse Outcomes in Healthy Aging Adults: Coronary Artery Disease, Lower Educational Status and Higher P-Selectin Levels

Geriatric nutritional risk index predicts all-cause mortality in the oldest-old patients with acute coronary syndrome: A 10-year cohort study

Prognosis of PCI in AMI setting in the elderly population: Outcomes from the multicenter prospective e‐ULTIMASTER registry

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