PMID- 36976424
OWN - NLM
STAT- MEDLINE
DCOM- 20230626
LR  - 20230626
IS  - 1615-2573 (Electronic)
IS  - 0910-8327 (Linking)
VI  - 38
IP  - 8
DP  - 2023 Aug
TI  - Acute coronary syndrome in very elderly patients-a real-world experience.
PG  - 1019-1027
LID - 10.1007/s00380-023-02260-x [doi]
AB  - Very elderly population constitutes an increasingly larger proportion of patients 
      admitted for acute coronary syndromes (ACS). Notably, age represents both a proxy 
      of frailty and an exclusion criterion in clinical randomized trials, which 
      probably contributes to lack of data and undertreatment of real-world elderly 
      patients. The aim of the study is to describe patterns of treatment and outcome 
      of very elderly patients with ACS. All consecutive patients aged >/= 80 years old 
      (yo) admitted between January 2017 and December 2019 with ACS were included. The 
      primary endpoint was in-hospital occurrence of major adverse cardiovascular 
      events (MACE), defined as the composite of cardiovascular death, new onset 
      cardiogenic shock, definite/probable stent thrombosis, and ischemic stroke. The 
      secondary endpoints were in-hospital incidence of Thrombolysis in Myocardial 
      Infarction (TIMI) major/minor bleedings, contrast-induced nephropathy (CIN), 
      six-month all-cause mortality, and unplanned readmission. One hundred 
      ninety-three patients (mean age 84.1 +/- 3.5 yo, 46% females) were included, of 
      whom 86 (44.6%), 79 (40.9%), and 28 (14.5%) presented with ST elevation 
      myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), 
      and unstable angina (UA), respectively. The vast majority of patients received an 
      invasive strategy, with 92.7% undergoing coronary angiography and 84.4% to 
      percutaneous coronary intervention (PCI). Aspirin was administered to 180 (93.3%) 
      patients, clopidogrel to 89 (46.1%) patients, and ticagrelor to 85 (44%) 
      patients. In-hospital MACE occurred in 29 patients (15.0%), whereas 3 (1.6%) and 
      12 patients (7.2%) experienced in-hospital TIMI major and TIMI minor bleeding, 
      respectively. Of the overall population, 177 (91.7%) were discharged alive. After 
      discharge, 11 patients (6.2%) died of all-cause death, whereas 42 patients 
      (23.7%) required a new hospitalization within six months. Invasive strategy of 
      ACS in elderly patients seems safe and effective. Six-month new hospitalization 
      appears inevitably related to age.
CI  - (c) 2023. Springer Nature Japan KK, part of Springer Nature.
FAU - Bianco, Matteo
AU  - Bianco M
AD  - Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, 
      Italy.
FAU - Mottola, Filiberto Fausto
AU  - Mottola FF
AD  - Chair of Cardiology, Department of Translational Medical Sciences, University of 
      Campania "Luigi Vanvitelli"-Monaldi Hospital, Naples, Italy.
FAU - Cerrato, Enrico
AU  - Cerrato E
AD  - Division of Cardiology, San Luigi Gonzaga University Hospital, Orbassano, Turin, 
      Italy.
FAU - Giordana, Francesca
AU  - Giordana F
AD  - Division of Cardiology, S. Croce and Carle Hospital, Via Michele Coppino, 26, 
      12100, Cuneo, Italy.
FAU - Cinconze, Sebastian
AU  - Cinconze S
AD  - Division of Cardiology, S. Croce and Carle Hospital, Via Michele Coppino, 26, 
      12100, Cuneo, Italy.
FAU - Baralis, Giorgio
AU  - Baralis G
AD  - Division of Cardiology, S. Croce and Carle Hospital, Via Michele Coppino, 26, 
      12100, Cuneo, Italy.
FAU - Verra, Alison
AU  - Verra A
AD  - Division of Cardiology, S. Croce and Carle Hospital, Via Michele Coppino, 26, 
      12100, Cuneo, Italy.
FAU - Musumeci, Giuseppe
AU  - Musumeci G
AD  - Division of Cardiology, Ordine Mauriziano Di Torino Hospital, Turin, Italy.
FAU - Rossini, Roberta
AU  - Rossini R
AD  - Division of Cardiology, S. Croce and Carle Hospital, Via Michele Coppino, 26, 
      12100, Cuneo, Italy. roberta.rossini2@gmail.com.
LA  - eng
PT  - Journal Article
DEP - 20230328
PL  - Japan
TA  - Heart Vessels
JT  - Heart and vessels
JID - 8511258
RN  - A74586SNO7 (Clopidogrel)
RN  - R16CO5Y76E (Aspirin)
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Female
MH  - Humans
MH  - Aged
MH  - Aged, 80 and over
MH  - Male
MH  - *Acute Coronary Syndrome/diagnosis/therapy/complications
MH  - *Percutaneous Coronary Intervention/adverse effects
MH  - *Myocardial Infarction/complications
MH  - Clopidogrel/adverse effects
MH  - Aspirin/adverse effects
MH  - Hemorrhage/chemically induced/epidemiology
MH  - *Non-ST Elevated Myocardial Infarction/diagnosis/therapy
MH  - Treatment Outcome
MH  - Platelet Aggregation Inhibitors/adverse effects
OTO - NOTNLM
OT  - Acute coronary syndromes
OT  - Percutaneous coronary intervention
OT  - Real world
OT  - Very elderly
EDAT- 2023/03/29 06:00
MHDA- 2023/06/26 06:42
CRDT- 2023/03/28 11:19
PHST- 2022/10/06 00:00 [received]
PHST- 2023/03/08 00:00 [accepted]
PHST- 2023/06/26 06:42 [medline]
PHST- 2023/03/29 06:00 [pubmed]
PHST- 2023/03/28 11:19 [entrez]
AID - 10.1007/s00380-023-02260-x [pii]
AID - 10.1007/s00380-023-02260-x [doi]
PST - ppublish
SO  - Heart Vessels. 2023 Aug;38(8):1019-1027. doi: 10.1007/s00380-023-02260-x. Epub 
      2023 Mar 28.