Contemporary Revascularization Dilemmas in Older Adults

Kumar, Sonali; McDaniel, Michael; Samady, Habib; Forouzandeh, Farshad

doi:10.1161/jaha.119.014477

Cited by 39 publications

(46 citation statements)

References 65 publications

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“…23 & 24 It was found that elderly MVD presented with AMI had multiple morbidities and were at high-risk in terms of mortality and adverse events even after revascularization and that's similar to what was concluded by the previous studies. 25 & 26 …”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Short-Term Outcomes of Patients Presenting with Acute Myocardial Infarction having Multi-vessel disease - A Single Middle- eastern Tertiary-Care Center Experience

Khaled

Jaha

Shalaby

2022

Indian Heart Journal

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Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Short-Term Outcomes of Patients Presenting with Acute Myocardial Infarction having Multi-vessel disease - A Single Middle- eastern Tertiary-Care Center Experience

Khaled

Jaha

Shalaby

2022

Indian Heart Journal

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“…In our study STEMI is a large proportion of the total PCI in elderly. Second, as many other trials randomized study was subject to many exclusions such as cardiogenic shock, continuing bleeding problems, short life expectancy [24]. This was not the case in our study.…”

Section: Discussionmentioning

confidence: 72%

Percutaneous Coronary Interventions in Elderly Patients: Experience from a Tertiary Care Center from Developing Country

2021

COA

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Objective of the study: To assess the outcome of Percutaneous coronary intervention in elderly in terms of success and complications. Methods: Retrospective data review of 887 consecutive cases of percutaneous interventions done at Karachi institute of heart diseases from 2015-2020. We divided the patients in three age groups younger (<65 years, n=592); older (65 to 75 years, n=201); and elderly (>=75 years, n=94). Immediate and six months outcomes of in hospital vascular complications, death, myocardial infarction, repeat target lesion revascularization and stroke were compared between these groups. Result: The vascular complications was in three groups (relative risk 3.2% vs 2.9% vs 4.3% with p=0.56) respectively. The relative risk of periprocedural Myocardial infarction in elderly/older patients was not higher than young patients with (OR of 0.6 with 95% CI 0.3 vs 1.4 with P=0.35), so was the need of repeat target revascularization with (OR of 0.3 95% CI 0.2 vs -1.6 with P=0.85), the risk of stroke following procedure was minimal (OR of 0.7 95% CI 0.4 vs 1.6 P=0.4). The in-hospital mortality was higher in elderly with (OR with 95% CI 1.0 vs 2.0 vs 3.4 P=0.03) in three groups. The six months outcomes of myocardial infarction in elderly were also not higher than younger pts (OR 0.7 vs 0.4 P=0.58). so was the need for repeat target revascularization (OR 0.5 vs 0.3 P=0.6). The six-month mortality in three groups was high in elderly (OR with 95% CI 1.5% vs 3.4% vs 4% with P value of 0.04). Conclusion: The procedure success in elderly patients was similar to younger patients, but in hospital and six months mortality was higher in elderlies.

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“…The results, however, are very confusingly different: The risk of stroke/death in simultaneous CEA and CABG is highest and lowest in a stepwise approach [45], [46]; in a registry of 27,084 patients in the CAS-CABG versus CEA-CABG strategies, the incidence of postoperative stroke was 2.4% versus 3.9% (p < 0.001) and of stroke/death 6.9% versus 8.6% (p = 0.1) [47]; according to Versaci et al CAS immediately before CABG gives promising results with a low incidence of death/stroke [48]; 132 patients treated with CAS and CABG on the same day had an in-hospital stroke rate of 0.75% and a 5-and 10-year period free from neurological events of 95% and 85%, respectively; analysis in 350 patients with staged CEA, followed up to 90 days after CABG showed the worst results for MI between revascularization stages [49]. In recent studies by the teams of Sulženko [19] (2019), Kumar et al [50] (2020), Shen et al [51], Manthey et al [52] (2020), Tzoumas et al [53] (2020) results and opinions are mixed, but the need to utilize the effect of CEA/CAS in underlying coronary stenosis by revascularization of both vascular areas is a common opinion. Addressing this problem, our results in high-risk patients show that stepwise PCI before CAS yields significantly better MS than revascularization after CAS (χ 2 = 5.306, p = 0.018).…”

Section: Discussionmentioning

confidence: 99%

Survival and Prognostic Factors After Carotid Artery Stenting in Patients with Concomitant Coronary Disease

Goranov

Tokmakova

Nikolov

2021

Open Access Maced J Med Sci

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AIM: The aim of the study was to analyze the prognostic factors in patients after carotid artery stenting (CAS). METHODS: In 329 patients after CAS, the median survival (MS) and overall survival (OS) were calculated for a follow-up period of 2–101 months. All patients underwent coronary angiography before carotid stenting and, if indicated, coronary revascularization. Four groups of factors were analyzed: Carotid disease, coronary artery disease (CAD), underlying cardiac pathology, and concomitant diseases. RESULTS: MS in all patients was 86 months, OS at 1, 3, 5, and 9 years was - 94%, 85%, 73%, and 51%, respectively. Event free survival was 85 months. Log Rank-Mantel-Cox analysis demonstrated significantly reduced MS in 21 tested factors, most of them related to CAD. Two-step multifactorial Cox regression analysis defined only 7 of them as independent prognostic factors for the survival of patients after CAS: Left main stenosis, complete revascularization, late myocardial infarction, stroke, age over 70 years, valvular disease, and carotid score. CONCLUSION: Survival of patients after CAS is limited mainly by CAD and underlying cardiac pathology. Staged revascularization treatment strategy may improve the prognosis and survival of patients with both carotid and coronary disease.

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Contemporary Revascularization Dilemmas in Older Adults

Cited by 39 publications

References 65 publications

Clinical Characteristics and Short-Term Outcomes of Patients Presenting with Acute Myocardial Infarction having Multi-vessel disease - A Single Middle- eastern Tertiary-Care Center Experience

Clinical Characteristics and Short-Term Outcomes of Patients Presenting with Acute Myocardial Infarction having Multi-vessel disease - A Single Middle- eastern Tertiary-Care Center Experience

Percutaneous Coronary Interventions in Elderly Patients: Experience from a Tertiary Care Center from Developing Country

Survival and Prognostic Factors After Carotid Artery Stenting in Patients with Concomitant Coronary Disease

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