Acute coronary syndrome in very elderly patients—a real-world experience

Bianco, Matteo; Mottola, Filiberto Fausto; Cerrato, Enrico; Giordana, Francesca; Cinconze, Sebastian; Baralis, Giorgio; Verra, Alison; Musumeci, Giuseppe; Rossini, Roberta

doi:10.1007/s00380-023-02260-x

Cited by 3 publications

(2 citation statements)

References 37 publications

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“…CLTI was defined as ischaemic rest pain lasting for 2 or more weeks, non-healing wounds, or gangrene that was attributable to objectively proven arterial occlusive disease. A MACE was defined as non-fatal stroke, non-fatal myocardial infarction, or cardiovascular death 21 . A MALE was defined as acute limb ischaemia, untreated loss of patency, or major lower limb amputation 22 .…”

Section: Methodsmentioning

confidence: 99%

Tailored risk assessment and forecasting in intermittent claudication

Ravindhran,

Prosser,

Lim

et al. 2024

BJS Open

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Background Guidelines recommend cardiovascular risk reduction and supervised exercise therapy as the first line of treatment in intermittent claudication, but implementation challenges and poor patient compliance lead to significant variation in management and therefore outcomes. The development of a precise risk stratification tool is proposed through a machine-learning algorithm that aims to provide personalized outcome predictions for different management strategies. Methods Feature selection was performed using the least absolute shrinkage and selection operator method. The model was developed using a bootstrapped sample based on patients with intermittent claudication from a vascular centre to predict chronic limb-threatening ischaemia, two or more revascularization procedures, major adverse cardiovascular events, and major adverse limb events. Algorithm performance was evaluated using the area under the receiver operating characteristic curve. Calibration curves were generated to assess the consistency between predicted and actual outcomes. Decision curve analysis was employed to evaluate the clinical utility. Validation was performed using a similar dataset. Results The bootstrapped sample of 10 000 patients was based on 255 patients. The model was validated using a similar sample of 254 patients. The area under the receiver operating characteristic curves for risk of progression to chronic limb-threatening ischaemia at 2 years (0.892), risk of progression to chronic limb-threatening ischaemia at 5 years (0.866), likelihood of major adverse cardiovascular events within 5 years (0.836), likelihood of major adverse limb events within 5 years (0.891), and likelihood of two or more revascularization procedures within 5 years (0.896) demonstrated excellent discrimination. Calibration curves demonstrated good consistency between predicted and actual outcomes and decision curve analysis confirmed clinical utility. Logistic regression yielded slightly lower area under the receiver operating characteristic curves for these outcomes compared with the least absolute shrinkage and selection operator algorithm (0.728, 0.717, 0.746, 0.756, and 0.733 respectively). External calibration curve and decision curve analysis confirmed the reliability and clinical utility of the model, surpassing traditional logistic regression. Conclusion The machine-learning algorithm successfully predicts outcomes for patients with intermittent claudication across various initial treatment strategies, offering potential for improved risk stratification and patient outcomes.

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Section: Methodsmentioning

confidence: 99%

Tailored risk assessment and forecasting in intermittent claudication

Ravindhran,

Prosser,

Lim

et al. 2024

BJS Open

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“…Jointly, the trial suggested an expansion of ticagrelor's benefits, which persisted independently of type of ACS, and resulted in a change in guidelines, which recommend ticagrelor (or prasugrel) rather than clopidogrel as P2Y12i in ACS patients. However, several studies have challenged some of the trial conclusions and questioned the real benefit of ticagrelor, particularly in high-bleedingrisk populations such as East Asians [102] or the elderly [103,104]. In the POPular AGE trial [105], involving >1000 patients aged > 70 and with NSTE-ACS, clopidogrel resulted in a reduction in bleeding events without an increase in net adverse clinical events (NACE).…”

Section: Ticagrelormentioning

confidence: 99%

Current Strategies to Guide the Antiplatelet Therapy in Acute Coronary Syndromes

Russo,

Brookles,

Barale

et al. 2024

IJMS

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The role of antiplatelet therapy in patients with acute coronary syndromes is a moving target with considerable novelty in the last few years. The pathophysiological basis of the treatment depends on platelet biology and physiology, and the interplay between these aspects and clinical practice must guide the physician in determining the best therapeutic options for patients with acute coronary syndromes. In the present narrative review, we discuss the latest novelties in the antiplatelet therapy of patients with acute coronary syndromes. We start with a description of platelet biology and the role of the main platelet signal pathways involved in platelet aggregation during an acute coronary syndrome. Then, we present the latest evidence on the evaluation of platelet function, focusing on the strengths and weaknesses of each platelet’s function test. We continue our review by describing the role of aspirin and P2Y12 inhibitors in the treatment of acute coronary syndromes, critically appraising the available evidence from clinical trials, and providing current international guidelines and recommendations. Finally, we describe alternative therapeutic regimens to standard dual antiplatelet therapy, in particular for patients at high bleeding risk. The aim of our review is to give a comprehensive representation of current data on antiplatelet therapy in patients with acute coronary syndromes that could be useful both for clinicians and basic science researchers to be up-to-date on this complex topic.

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