Coronary artery lesion phenotype in frail older patients with non-ST-elevation acute coronary syndrome undergoing invasive care

Gu, Sophie Zhaotao; Qiu, Weiliang; Batty, Jonathan A.; Sinclair, Hannah; Veerasamy, Murugapathy; Brugaletta, Salvatore; Neely, Dermot; Ford, Gary A.; Pa, Calvert; Gs, Mintz; Kunadian,

doi:10.4244/eij-d-18-00848

Cited by 22 publications

(16 citation statements)

References 25 publications

(24 reference statements)

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“…The Improve Cardiovascular Outcomes in high-risk older patients with acute coronary syndrome (ICON1) study is a multicentre prospective cohort study which aimed to develop a risk score for high-risk older adults, the FRAIL-HEART score. [7][8][9] The study protocol has been published previously [10]. The current study is a planned study as outlined in the the ICON1 study protocol [10].…”

Section: Methodsmentioning

confidence: 99%

The association of telomere length and telomerase activity with adverse outcomes in older patients with non-ST-elevation acute coronary syndrome

et al. 2020

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Background Non-ST elevation acute coronary syndrome (NSTEACS) occurs more frequently in older patients with an increased occurrence of recurrent cardiac events following the index presentation. Telomeres are structures consisting of repeated DNA sequences as associated shelterin proteins at the ends of chromosomes. We aim to determine whether telomere length (TL) and telomerase activity (TA) predicted poor outcomes in older patients presenting with NSTEACS undergoing invasive care. Method Older patients undergoing invasive management for NSTEACS were recruited to the ICON-1 biomarker study (NCT01933581). Peripheral blood mononuclear cells (PBMC) were recovered on 153 patients. DNA was isolated and mean TL was measured by quantitative PCR expressed as relative T (telomere repeat copy number) to S (single copy gene number) ratio (T/S ratio), and a telomere repeat amplification assay was used to assess TA during index presentation with NSTEACS. Primary clinical outcomes consisted of death, myocardial infarction (MI), unplanned revascularisation, stroke and significant bleeding recorded at 1 year. TL and TA were divided into tertile groups for analysis. Cox proportional hazards regression was performed. Ordinal regression was performed to evaluate the relationship between TL and TA and traditional cardiovascular risk factors at baseline. Results 298 patients were recruited in the ICON-1 study of which 153 had PBMC recovered. The mean age was 81.0 ± 4.0 years (64% male). Mean telomere length T/S ratio was 0.47 ±

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Section: Methodsmentioning

confidence: 99%

The association of telomere length and telomerase activity with adverse outcomes in older patients with non-ST-elevation acute coronary syndrome

et al. 2020

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“…The ICON1 study is a multi-centre prospective cohort study that aims to determine the predictors of adverse outcomes following interventional management of NSTEACS in older patients, with an overall aim of producing a quantitative risk score for this population, the FRAIL-HEART score. [15] [16, 17]…”

Section: Methodsmentioning

confidence: 99%

The association between vitamin D status and clinical events in high-risk older patients with non-ST elevation acute coronary syndrome undergoing invasive management

Beska

Chan

et al. 2019

PLoS ONE

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There is a higher incidence of vitamin D deficiency in older adults. This may play a plausible mechanistic role in the occurrence of increased adverse events after non-ST elevation acute coronary syndrome (NSTEACS). This study investigated whether total vitamin D levels at the time of presentation predicted adverse outcomes in older adults undergoing invasive management of NSTEACS. Of the 629 patients screened, 300 high-risk older adults with NSTEACS managed by an invasive strategy were recruited. Serum total 25-hydroxyvitamin D was measured at index presentation. The primary outcome was defined as 1-year composite of all-cause mortality, acute coronary syndrome (ACS), unplanned repeat revascularisation, significant bleeding or stroke. Mean age was 80.5±4.8 years (61.9% male). Median vitamin D level was 29.5nmol/L [interquartile range IQR 16.0–53.0 nmol/L] and was split equally by the median for analysis forming two groups: high (median vitamin D 53.0 nmol/L [IQR 40.0–75.0]) and low (16.0 nmol/L [11.0–23.0]). The primary outcome occurred in 76 patients (25.9%); 32 (21.9%) in the low group and 44 (29.9%) in the high group, p = 0.12. Multivariable analyses showed no significant difference in the primary composite outcome at 1 year between the low and high group of baseline serum vitamin D (Hazard Ratio 1.20 [95% Confidence Interval 0.72–2.0], p = 0.48). Serum total vitamin D, measured at the time of angiography, was not associated with adverse outcomes at one year in this high-risk older cohort of patients with NSTEACS undergoing invasive management.

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“…Frail adults presenting with NSTEACS have more procedurally challenging angiographic characteristics, independent of age. 16 , 17 In age- and sex-adjusted logistic regression analysis, frailty is associated with severe culprit lesion calcification [odds ratio (OR) 5.13, 95% confidence interval (CI) 1.59–16.5, P = 0.006]. Frail patients had a 2.67 increased odds of being within the highest SYNTAX tertile compared with robust patients and a greater presence of high-risk lesions on virtual history intravascular ultrasound imaging, with a 2.81 increased adjusted odds (95% CI 1.06–7.48, P = 0.039) of presence of thin-cap fibroatheroma, independent of age.…”

Section: Characteristics Of Older Adults With Acute Coronary Syndromementioning

confidence: 99%

“…Frail patients had a 2.67 increased odds of being within the highest SYNTAX tertile compared with robust patients and a greater presence of high-risk lesions on virtual history intravascular ultrasound imaging, with a 2.81 increased adjusted odds (95% CI 1.06–7.48, P = 0.039) of presence of thin-cap fibroatheroma, independent of age. 16 Frailty predicts an increase in composite of all-cause mortality, myocardial infarction (MI), stroke, unplanned revascularization, and major bleeding at 1 year among older patients with NSTEACS receiving CAG. 13 Importantly, older NSTEACS adults with frailty have poor HRQoL at baseline.…”

Section: Characteristics Of Older Adults With Acute Coronary Syndromementioning

confidence: 99%

Is the contemporary care of the older persons with acute coronary syndrome evidence-based?

Mills

Ratcovich

Adams‐Hall

et al. 2021

European Heart Journal Open

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Globally, ischaemic heart disease is the leading cause of death, with a higher mortality burden amongst older adults. Although advancing age is associated with a higher risk of adverse outcomes following acute coronary syndromes (ACS), older patients are less likely to receive evidence-based medications and coronary angiography. Guideline recommendations for managing ACS are often based on studies that exclude older patients, and more contemporary trials have been underpowered and produced inconsistent findings. There is also limited evidence for how frailty and comorbidity should influence management decisions. This review focuses on the current evidence base for the medical and percutaneous management of ACS in older patients and highlights the distinct need to enrol older patients with ACS into well-powered, large-scale randomised trials.

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Coronary artery lesion phenotype in frail older patients with non-ST-elevation acute coronary syndrome undergoing invasive care

Cited by 22 publications

References 25 publications

The association of telomere length and telomerase activity with adverse outcomes in older patients with non-ST-elevation acute coronary syndrome

The association of telomere length and telomerase activity with adverse outcomes in older patients with non-ST-elevation acute coronary syndrome

The association between vitamin D status and clinical events in high-risk older patients with non-ST elevation acute coronary syndrome undergoing invasive management

Is the contemporary care of the older persons with acute coronary syndrome evidence-based?

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