Untitled

Claude, J M; Schindler, Christian; Kuster, Gabriela M.; Schwenkglenks, Matthias; Szucs, Thomas D.; Buser, Peter; Oßwald, Stefan; Kaiser, Christoph; Grädel, Christoph; Estlinbaum, Werner; Rickenbacher, Peter; Pfisterer, Matthias

doi:10.1016/j.ehj.2004.09.013

Cited by 43 publications

(5 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“… 20 In terms of cost-effectiveness, one study reported that invasive treatment had a similar benefit to medical management in elderly patients with chronic angina symptoms. 21 However, within clinical practice, PCI is underused in older patients (≥75 years old) with acute coronary syndrome, especially in those with more complex risk factors. 7 …”

Section: Discussionmentioning

confidence: 99%

Percutaneous Coronary Intervention Is More Beneficial Than Optimal Medical Therapy in Elderly Patients with Angina Pectoris

et al. 2016

View full text Add to dashboard Cite

PurposeData comparing the clinical benefits of medical treatment with those of percutaneous coronary intervention (PCI) in an elderly population with angina pectoris are limited. Therefore, we evaluated the efficacy of elective PCI versus optimal medical treatment (OMT) in elderly patients (between 75 and 84 years old) with angina pectoris.Materials and MethodsOne hundred seventy-seven patients with significant coronary artery stenosis were randomly assigned to either the PCI group (n=90) or the OMT group (n=87). The primary outcome was a composite of major adverse events in the 1-year follow-up period that included cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and stroke.ResultsMajor adverse events occurred in 5 patients (5.6%) of the PCI group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no significant differences between the PCI group and the OMT group in cardiac death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval (CI) 0.041–5.019, p=0.520], myocardial infarction (HR 0.399; 95% CI 0.039–4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057–14.709, p=0.952). However, the PCI group showed a significant preventive effect of the composite of major adverse events (HR 0.288; 95% CI 0.106–0.785, p=0.015) and against the need for coronary revascularization (HR 0.157; 95% CI 0.035–0.703, p=0.016).ConclusionElective PCI reduced major adverse events and was found to be an effective treatment modality in elderly patients with angina pectoris and significant coronary artery stenosis, compared to OMT.

show abstract

Section: Discussionmentioning

confidence: 99%

Percutaneous Coronary Intervention Is More Beneficial Than Optimal Medical Therapy in Elderly Patients with Angina Pectoris

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The results of the cost-effectiveness analysis of PCI plus OMT versus OMT alone have varied across different trials. The TIME and FAME 2 trials indicated that PCI plus OMT was more cost-effective than OMT, suggesting favorable economic outcomes associated with the intervention 53,54 . However, analyses from trials such as COURAGE and BARI 2D reported contrasting findings, indicating that PCI plus OMT may not always be the more cost-effective option compared to OMT alone 55,56 .…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Coronary Intervention versus Optimal Medical Therapy on Quality of Life and Functional Capacity Assessment in Chronic Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

Ibrahim,

Allihien,

Addo

et al. 2024

Preprint

View full text Add to dashboard Cite

BackgroundPrevious studies have primarily examined the impact of percutaneous coronary intervention (PCI) compared to optimal medical therapy (OMT) on hard outcomes such as all-cause mortality, cardiovascular death, nonfatal myocardial infarction, and the need for revascularization in patients with chronic coronary syndrome (CCS). However, these studies have not yielded significant findings thus far.ObjectiveThe goal of this meta-analysis was to assess the effect of PCI plus OMT on quality of life (QoL), functional capacity (FC), and angina-related health status compared to OMT alone in patients with CCS.MethodCochrane Central Registry of Controlled Trials, PubMed, Embase, and clininalTrials.gov were searched for studies published up to December 2023. The outcomes of interest were quality of life (QoL), freedom from angina (FFA), angina frequency (AF), and functional capacity (FC) measured with Seatle Angina Questionnaire (SAQ) or its equivalents such as EuroQol-5D (EQ-5D), 36-Item Short Form (SF-36) or RAND-36, and psychological well-being score if none is available. Additionally, the Duke Activity Status Index was also used to assess functional capacity when reported. Fixed-effect model was used for data analysis if I2statistics <50%; otherwise, the random-effect model was used. Sensitivity analysis was performed by using the leave-one-out meta-analysis which alternatively removes a trial from the study to assess its impact on the result as well as the interconversion between fixed-effects and random-effects models. A meta-regression analysis was also performed to evaluate the impact of covariates on QoL. Cochrane Risk of Bias Assessment Tool was used to assess the risk of bias.ResultsSeventeen randomized controlled trials that enrolled 13,588 patients satisfied our inclusion and exclusion criteria with an average age of 62.3±10 years. PCI plus OMT improved QoL with standardized mean difference (SMD) of 0.27 ([95% CI, 0.14-0.40]; P <0.001) and 0.21 ([95% CI, 0.12-0.30]; P <0.001) when compared to OMT alone at 6 months and 1 year respectively. PCI plus OMT was also associated with significant improvement in FFA (1.17 [95% CI, 1.11-1.24]; P < 0.001), AF (0.25 [95% CI, 0.20-0.30]; P <0.001), and FC (0.21 [95% CI, 0.12-0.31]; P <0.001) at 6 months and persisted at 3 years (QoL [0.18 [95% CI, 0.06-0.30]; P < 0.001], FFA [1.27 [95% CI, 1.11-1.45]; P < 0.001], AF [0.09 [95% CI, 0.02-0.16]; P = 0.009], FC [0.13 [95% CI, 0.02-0.23]; P = 0.02] respectively) . However, there appears to be a reduction in this effect with time. Meta-regression analysis using year of publication as covariate on QoL was performed. There was no statistically significant relationship between the year of publication and QoL at 1 year (P = 0.81).ConclusionIn this meta-analysis, PCI combined with OMT was associated with better quality of life, greater freedom from angina, reduction in angina frequency, and improved functional capacity compared to OMT alone. These benefits persisted when followed longitudinally for 3 years. However, longer-term outcome data of these trials is needed to determine whether these improvements in quality of life are sustained or attenuated over time.

show abstract

“…Our results are consistent with earlier observations that as many as 62.4% of cardiac catheterizations in patients with CAD do not confirm the presence of significant changes in the coronary vessels [ 20 ]. Thus, it can be perceived as unnecessarily exposing patients to procedure-related risks and incurring unwanted health care costs [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although previous studies have not proven that invasive treatment of stable angina, an important clinical symptom of CAD observed among older adults, will always result in lower mortality rates compared to conservative treatment, recent research suggests that percutaneous coronary angioplasty (PTCA) using new-generation drug-eluting stents and coronary artery bypass grafting may not only improve the well-being of older patients affected by chronic CAD but also positively influence the prognosis [ 10 ]. From the healthcare organizers’ point of view, cost-effectiveness analysis results are also critical, as they indicate that PTCA treatment in older patients can cut treatment costs in the long run [ 11 ]. Therefore, it may be expected that in the coming years there will be an increase in cardiac catheterization in elderly patients to assess the need for surgical or PTCA treatment of stable angina.…”

Section: Introductionmentioning

confidence: 99%

A Newly Defined CHA2DS2-VA Score for Predicting Obstructive Coronary Artery Disease in Patients with Atrial Fibrillation—A Cross-Sectional Study of Older Persons Referred for Elective Coronary Angiography

Wojszel

Kuźma

Rogalska

et al. 2022

JCM

View full text Add to dashboard Cite

Purpose: Atrial fibrillation (AF) can be a valuable indicator of non-obstructive coronary artery disease (CAD) among older patients indicated for elective coronary angiography (CAG). Appropriate stratification of AF patients is crucial for avoiding unnecessary complications. The objective of this study was to identify independent predictors that can allow diagnosing obstructive CAD in AF patients over 65 years who were indicated to undergo elective CAG. Patients and methods: This cross-sectional study included 452 (23.9%) AF patients over 65 years old who were directed to the Department of Invasive Cardiology at the Medical University of Bialystok for elective CAG during 2014–2016. The participants had CAD and were receiving optimal therapy (median age: 73 years, interquartile range: 69–77 years; 54.6% men). The prevalence and health correlates of obstructive CAD were determined, and a multivariate logistic regression model was generated with predictors (p < 0.1). Predictive performance was analyzed using a receiver-operating characteristic (ROC) curve analysis. Results: Stenosis (affecting ≥ 50% of the diameter of the left coronary artery stem or ≥70% of that of the other important epicardial vessels) was significant in 184 (40.7%) cases. Multivariate regression analysis revealed that only the male sex (odds ratio [OR]: 1.80, 95% confidence interval [CI]: 1.14–2.84, p = 0.01) and the newly created CHA2DS2-VA score (OR: 3.96, 95% CI: 2.96–5.31, p < 0.001) significantly increased the chance of obstructive CAD, while controlling for chronic kidney disease and anemia. The ROC curve analysis indicated that the CHA2DS2-VA scale may be a useful screening tool for the diagnosis of obstructive CAD (area under the ROC curve: 0.79, 95% CI: 0.75–0.84, p < 0.001), with ≥4 being the optimal cutoff value. Conclusions: Our study has proven that several older AF patients who are advised to undergo elective CAG have nonobstructive CAD. The CHA2DS2-VA score can contribute to improving the selection of patients for invasive diagnosis of CAD, but further investigation is required.

show abstract

Untitled

Cited by 43 publications

References 21 publications

Percutaneous Coronary Intervention Is More Beneficial Than Optimal Medical Therapy in Elderly Patients with Angina Pectoris

Percutaneous Coronary Intervention Is More Beneficial Than Optimal Medical Therapy in Elderly Patients with Angina Pectoris

Percutaneous Coronary Intervention versus Optimal Medical Therapy on Quality of Life and Functional Capacity Assessment in Chronic Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials

A Newly Defined CHA2DS2-VA Score for Predicting Obstructive Coronary Artery Disease in Patients with Atrial Fibrillation—A Cross-Sectional Study of Older Persons Referred for Elective Coronary Angiography

Contact Info

Product

Resources

About