One-year clinical outcomes in older patients with non-ST elevation acute coronary syndrome undergoing coronary angiography: An analysis of the ICON1 study

Batty, Jonathan A.; Qiu, Weiliang; Gu, Sophie Zhaotao; Sinclair, Hannah; Veerasamy, Murugapathy; Beska, Benjamin; Neely, Dermot; Ford, Gary A.; Kunadian, Vijay; Investigators, Icon Study

doi:10.1016/j.ijcard.2018.09.086

Cited by 38 publications

(40 citation statements)

References 23 publications

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“…In previous analysis of the ICON1 cohort by this group, frailty had a 2.79 increased hazard (95% CI 1.28–6.08, P = 0.01) for the primary end-point at 1-year compared to those that were robust. [15] Frailty has been linked to vitamin D deficiency in a number of studies,[24, 25] with our study confirming the finding in older adults presenting with NSTEACS. Those with lower levels of serum vitamin D were found to be significantly more co-morbid, with an increased Charlson co-morbidity index, and be frailer than those with higher levels of serum vitamin D. The relationship between frailty and increased CVD risk, combined with the increased incidence of vitamin D deficiency in older adults, might go some way to explain the excess CVD risk in older adults.…”

Section: Resultssupporting

confidence: 89%

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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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Section: Resultssupporting

confidence: 89%

“…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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“…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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“…The screening log data from this study have been published previously 20 . In total, 298 patients were enrolled in the ICON1 study and the one-year clinical outcomes for the whole study have been published 21 . The current invasive imaging subgroup analysis included data from 90 patients.…”

Section: Methodsmentioning

confidence: 99%

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

Qiu²,

Batty³

et al. 2019

EuroIntervention

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Aims:The association of frailty with coronary plaque phenotype among older patients with non-ST-elevation acute coronary syndrome (NSTEACS) is not known. The aim of this study was to evaluate the association of frailty with coronary plaque phenotype among older patients with NSTEACS.Methods and results: Older patients with NSTEACS who underwent invasive angiography were recruited. Frailty was measured using the Fried frailty score. Following angiography, patients underwent greyscale and virtual histology intravascular ultrasound (VH-IVUS) imaging. Of the 90 patients, 26 (28.9%) were robust, 49 (54.4%) patients were pre-frail, and 15 (16.7%) were frail. Mean age was 80.9±3.8 years; 59 (65.6%) were male. Compared to robust patients, the pre-frail group had a significantly greater presence of high-risk lesions including VH thin-cap fibroatheroma (TCFA, p=0.011), minimum lumen area (MLA) ≤4 mm 2 (p=0.016), TCFA+MLA ≤4 mm 2 (p=0.005), TCFA+plaque burden (PB) ≥70% (p=0.005) and TCFA+PB ≥70%+MLA ≤4 mm 2 (p=0.003). By age-and sex-adjusted logistic regression analysis, frailty was found to be strongly and independently associated with the presence of TCFA (odds ratio [OR] 2.81, 95% confidence interval [CI]:1.06-7.48, p=0.039).Conclusions: This is the first study to report the relationship between frailty phenotype and coronary plaque morphology among frail older NSTEACS patients. ClinicalTrials.gov Identifier: NCT01933581

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One-year clinical outcomes in older patients with non-ST elevation acute coronary syndrome undergoing coronary angiography: An analysis of the ICON1 study

Cited by 38 publications

References 23 publications

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

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

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

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

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