Comorbidity burden and revascularization benefit in elderly patients with acute coronary syndrome

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.rec.2020.06.015

Cited by 13 publications

(21 citation statements)

References 30 publications

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“…This policy seems to be based on the assumption that guideline-recommended treatments bring only marginal benefit in these patients. Management of older patients with frailty or comorbidities is certainly challenging [ 29 , 30 ]. In our study, there were no differences in the medical treatment prescribed at discharge, but patients with cognitive impairment tended to undergo fewer revascularization procedures.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, there were no differences in the medical treatment prescribed at discharge, but patients with cognitive impairment tended to undergo fewer revascularization procedures. Other studies have also observed that old patients with acute coronary syndrome and comorbidities less often undergo invasive management and in-hospital revascularization, although most of them might benefit from revascularization [ 30 ]. The indication of invasive management in patients with cognitive impairment is challenging.…”

Section: Discussionmentioning

confidence: 99%

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Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

Forés

Bonanad

García‐Blas

et al. 2021

JCM

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Frailty is a marker of poor prognosis in older adults after acute coronary syndrome. We investigated whether cognitive impairment provides additional prognostic information. The study population consisted of a prospective cohort of 342 older (>65 years) adult survivors after acute coronary syndrome. Frailty (Fried score) and cognitive function (Pfeiffer’s Short Portable Mental Status Questionnaire—SPMSQ) were assessed at discharge. The endpoints were mortality or acute myocardial infarction at 8.7-year median follow-up. Patient distribution according to SPMSQ results was: no cognitive impairment (SPMSQ = 0 errors; n = 248, 73%), mild impairment (SPMSQ = 1–2 errors; n = 52, 15%), and moderate to severe impairment (SPMSQ ≥3 errors; n = 42, 12%). A total of 245 (72%) patients died or had an acute myocardial infarction, and 216 (63%) patients died. After adjustment for clinical data, comorbidities, and Fried score, the SPMSQ added prognostic value for death or myocardial infarction (per number of errors; HR = 1.11, 95%, CI 1.04–1.19, p = 0.002) and death (HR = 1.11, 95% 1.03–1.20, p = 0.007). An SPMSQ with ≥3 errors identified the highest risk subgroup. Geriatric conditions (SPSMQ and Fried score) explained 19% and 43% of the overall chi-square of the models for predicting death or myocardial infarction and death, respectively. Geriatric assessment after acute coronary syndrome should include both frailty and cognitive function. This is particularly important given that cognitive impairment without dementia can be subclinical and thus remain undetected.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

Forés

Bonanad

García‐Blas

et al. 2021

JCM

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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

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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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“…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

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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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Comorbidity burden and revascularization benefit in elderly patients with acute coronary syndrome

Cited by 13 publications

References 30 publications

Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

Long-Term Prognostic Value of Cognitive Impairment on Top of Frailty in Older Adults after Acute Coronary Syndrome

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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