PMID- 35882457
OWN - NLM
STAT- MEDLINE
DCOM- 20220728
LR  - 20220818
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 12
IP  - 7
DP  - 2022 Jul 26
TI  - Impact of multimorbidity on long-term outcomes in older adults with non-ST 
      elevation acute coronary syndrome in the North East of England: a multi-centre 
      cohort study of patients undergoing invasive care.
PG  - e061830
LID - 10.1136/bmjopen-2022-061830 [doi]
LID - e061830
AB  - OBJECTIVES: Older adults have a higher degree of multimorbidity, which may 
      adversely affect longer term outcomes from non-ST elevation acute coronary 
      syndrome (NSTE-ACS). We investigated the impact of multimorbidity on 
      cardiovascular outcomes 5 years after invasive management of NSTE-ACS. DESIGN: 
      Prospective cohort study. SETTING: Multicentre study conducted in the north of 
      England. PARTICIPANTS: 298 patients aged >/=75 years with NSTE-ACS and referred for 
      coronary angiography, with 264 (88.0%) completing 5-year follow-up. MAIN OUTCOME 
      MEASURES: Multimorbidity was evaluated at baseline with the Charlson comorbidity 
      index (CCI). The primary composite outcome was all-cause mortality, myocardial 
      infarction, stroke, urgent repeat revascularisation or significant bleeding. 
      RESULTS: Mean age was 80.9 (+/-6.1) years. The cohort median CCI score was 5 (IQR 
      4-7). The primary composite outcome occurred in 48.1% at 5 years, at which time 
      31.0% of the cohort had died. Compared with those with few comorbidities (CCI 
      score 3-5), a higher CCI score (>/=6) was positively associated with the primary 
      composite outcome (adjusted HR (aHR) 1.64 (95% CI 1.14 to 2.35), p=0.008 adjusted 
      for age and sex), driven by an increased risk of death (aHR 2.20 (1.38 to 3.49), 
      p=0.001). For each additional CCI comorbidity, on average, there was a 20% 
      increased risk of the primary composite endpoint at 5 years (aHR 1.20 (1.09 to 
      1.33), p<0.001). CONCLUSIONS: In older adults with NSTE-ACS referred for coronary 
      angiography, the presence of multimorbidity is associated with an increased risk 
      of long-term adverse cardiovascular events, driven by a higher risk of all-cause 
      mortality. TRIAL REGISTRATION NUMBER: NCT01933581; ClinicalTrials.gov.
CI  - (c) Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No 
      commercial re-use. See rights and permissions. Published by BMJ.
FAU - Beska, Benjamin
AU  - Beska B
AD  - Translational and Clinical Research Institute, Faculty of Medical Sciences, 
      Newcastle University, Newcastle upon Tyne, UK.
AD  - Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS 
      Foundation Trust, Newcastle Upon Tyne, UK.
FAU - Mills, Greg B
AU  - Mills GB
AD  - Translational and Clinical Research Institute, Faculty of Medical Sciences, 
      Newcastle University, Newcastle upon Tyne, UK.
FAU - Ratcovich, Hanna
AU  - Ratcovich H
AD  - Translational and Clinical Research Institute, Faculty of Medical Sciences, 
      Newcastle University, Newcastle upon Tyne, UK.
AD  - Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, 
      Copenhagen, Denmark.
FAU - Wilkinson, Chris
AU  - Wilkinson C
AUID- ORCID: 0000-0003-0748-0150
AD  - Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS 
      Foundation Trust, Newcastle Upon Tyne, UK.
AD  - Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle 
      University, Newcastle upon Tyne, UK.
FAU - Damluji, Abdulla A
AU  - Damluji AA
AD  - Johns Hopkins University, Baltimore, Maryland, USA.
FAU - Kunadian, Vijay
AU  - Kunadian V
AUID- ORCID: 0000-0003-2975-6971
AD  - Translational and Clinical Research Institute, Faculty of Medical Sciences, 
      Newcastle University, Newcastle upon Tyne, UK vijay.kunadian@newcastle.ac.uk.
AD  - Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS 
      Foundation Trust, Newcastle Upon Tyne, UK.
LA  - eng
SI  - ClinicalTrials.gov/NCT01933581
GR  - K23 HL153771/HL/NHLBI NIH HHS/United States
GR  - P30 AG021334/AG/NIA NIH HHS/United States
GR  - BHF_/British Heart Foundation/United Kingdom
GR  - DH_/Department of Health/United Kingdom
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20220726
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
SB  - IM
MH  - *Acute Coronary Syndrome/epidemiology/etiology/therapy
MH  - Aged
MH  - Aged, 80 and over
MH  - Cohort Studies
MH  - Humans
MH  - Multimorbidity
MH  - *Percutaneous Coronary Intervention/adverse effects
MH  - Prospective Studies
MH  - Time Factors
MH  - Treatment Outcome
PMC - PMC9330324
OTO - NOTNLM
OT  - coronary heart disease
OT  - ischaemic heart disease
OT  - myocardial infarction
COIS- Competing interests: None declared.
EDAT- 2022/07/27 06:00
MHDA- 2022/07/29 06:00
PMCR- 2022/07/26
CRDT- 2022/07/26 21:03
PHST- 2022/07/26 21:03 [entrez]
PHST- 2022/07/27 06:00 [pubmed]
PHST- 2022/07/29 06:00 [medline]
PHST- 2022/07/26 00:00 [pmc-release]
AID - bmjopen-2022-061830 [pii]
AID - 10.1136/bmjopen-2022-061830 [doi]
PST - epublish
SO  - BMJ Open. 2022 Jul 26;12(7):e061830. doi: 10.1136/bmjopen-2022-061830.