Carga de comorbilidad y beneficio de la revascularización en ancianos con síndrome coronario agudo

Sanchís, Juan; Acuña, José María García; Raposeiras, Sergio; Barrabés, José A.; Cordero, Alberto; Martínez‐Sellés, Manuel; Bardajı́, Alfredo; Díez‐Villanueva, Pablo; Marı́n, Francisco; Ruiz-Nodar, Juan M.; Vicente‐Ibarra, Nuria; Salinas, Gonzalo Luis Alonso; Rigueiro, Pedro; Abu‐Assi, Emad; Formiga, F.; Núñez, Julio; Núñez, Eduardo; Arizá-Solé, Albert

doi:10.1016/j.recesp.2020.06.025

Cited by 16 publications

(5 citation statements)

References 30 publications

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“…Mortality increased with a higher number of comorbidities [ 20 ]. Evidence suggests that the benefits or revascularization in older patients diminish with more comorbidity burden [ 21 ].…”

Section: Comorbiditiesmentioning

confidence: 99%

Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction

Álvarez-Zaballos,

Juárez-Fernández,

Martínez-Sellés

2024

Rev. Cardiovasc. Med.

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With population aging and the subsequent accumulation of cardiovascular risk factors, a growing proportion of patients presenting with acute coronary syndrome (ACS) are octogenarian (aged between 80 and 89). The marked heterogeneity of this population is due to several factors like age, comorbidities, frailty, and other geriatric conditions. All these variables have a strong impact on outcomes. In addition, a high prevalence of multivessel disease, complex coronary anatomies, and peripheral arterial disease, increases the risk of invasive procedures in these patients. In advanced age, the type and duration of antithrombotic therapy need to be individualized according to bleeding risk. Although an invasive strategy for non-ST-segment elevation acute myocardial infarction (NSTEMI) is recommended for the general population, its need is not so clear in octogenarians. For instance, although frail patients could benefit from revascularization, their higher risk of complications might change the risk/benefit ratio. Age alone should not be the main factor to consider when deciding the type of strategy. The risk of futility needs to be taken into account and identification of risk factors for adverse outcomes, such as renal impairment, could help in the decision-making process. Finally, an initially selected conservative strategy should be open to a change to invasive management depending on the clinical course (recurrent angina, ventricular arrhythmias, heart failure). Further evidence, ideally from prospective randomized clinical trials is urgent, as the population keeps growing.

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“…Mortality increased with a higher number of comorbidities [ 20 ]. Evidence suggests that the benefits or revascularization in older patients diminish with more comorbidity burden [ 21 ].…”

Section: Comorbiditiesmentioning

confidence: 99%

Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction

Álvarez-Zaballos,

Juárez-Fernández,

Martínez-Sellés

2024

Rev. Cardiovasc. Med.

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“…After propensity score matching, it showed that revascularization within the first 3 days of admission was associated to 32% reduction in all-cause mortality (hazard ratio: 0.68, 95% CI 0.55-0.84). This study had several limitations because it did not assess the effect of heart failure of index hospitalization on post-discharge prognosis, and heart failure incidence was not assessed taking all-cause mortality as a competing event [34,35].…”

Section: Non-stemi (Nstemi) Patients: Invasive Versus Conservative Treatment?mentioning

confidence: 99%

“…In an observational study, Chang et al found a lack of benefit of invasive strategy in the subgroup with higher comorbidity burden (i.e., Charlson Index ≥ 4). On the other hand, a retrospective study with >7200 patients aged ≥ 70 years from 11 Spanish ACS registries analyzed the impact of the six most common comorbidities (diabetes, peripheral artery disease, cerebrovascular disease, chronic pulmonary disease, renal failure, and anemia) on revascularization, finding that revascularization reduced 1-year mortality despite the presence of comorbidities [35]. The MOSCA trial randomized routine invasive vs. conservative strategy in comorbid older patients with non-STEMI.…”

Section: Geriatric Conditions: Frailty and Comorbiditymentioning

confidence: 99%

Acute Coronary Syndrome in the Older Patient

García‐Blas

Cordero

Díez‐Villanueva

et al. 2021

JCM

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Coronary artery disease is one of the leading causes of morbidity and mortality, and its prevalence increases with age. The growing number of older patients and their differential characteristics make its management a challenge in clinical practice. The aim of this review is to summarize the state-of-the-art in diagnosis and treatment of acute coronary syndromes in this subgroup of patients. This comprises peculiarities of ST-segment elevation myocardial infarction (STEMI) management, updated evidence of non-STEMI therapeutic strategies, individualization of antiplatelet treatment (weighting ischemic and hemorrhagic risks), as well as assessment of geriatric conditions and ethical issues in decision making.

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“…Registry investigators provided individual patient data to form a pooled patient database. Details of the cohorts are reported elsewhere [22]. Briefly, the study included patients aged 70 years or older with NSTEACS.…”

Section: Study Populationmentioning

confidence: 99%

“…Few studies have addressed to date the interaction between sex and DM in the prognosis of elderly patients with NSTEACS, and they have had contradictory results [20,21]. The present study comprised a pooled analysis of individual patient data that included elderly patients from 11 Spanish NSTEACS registries [22]. We aimed to study the prognostic influence of DM according to sex on 1-year mortality.…”

Section: Introductionmentioning

confidence: 99%

Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome

Díez‐Villanueva

Garcı́a-Acuña

Raposeiras‐Roubín

et al. 2021

JCM

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Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p < 0.001) and more often had a history of hypertension (77% vs. 83.1%, p < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78; p < 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14; p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.

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Carga de comorbilidad y beneficio de la revascularización en ancianos con síndrome coronario agudo

Cited by 16 publications

References 30 publications

Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction

Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction

Acute Coronary Syndrome in the Older Patient

Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome

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