Estrategia invasiva frente a conservadora en pacientes frágiles con IAMSEST. Diseño del ensayo clínico MOSCA-FRAIL

Sanchís, Juan; Arizá-Solé, Albert; Abu‐Assi, Emad; Alegre, Oriol; Alfonso, Fernándo; Barrabés, José A.; Baz, José Antonio; Carol, Antonio; Villanueva, Pablo Díez; Blanco, Bruno García del; Elı́zaga, Jaime; Fernández, Eduard; Egido, Abel García del; Picard, Joan García; Blázquez, Iván Gómez; Hospital, Joan Antoni Gómez; Hernández‐Antolín, Rosana; Llibre, Cinta; Marı́n, Francisco; Sánchez, David Martí; Martín, Roberto; Sellés, Manuel Martínez; Miñana, Gema; Gallardo, María José Morales; Núñez, Julio; Prado, Armando Pérez de; Pinar, Eduardo; Sanmartı́n, Marcelo; Sionís, Alessandro; Villa, Adolfo; Marrugat, Jaume; Bueno, Héctor

doi:10.1016/j.recesp.2018.01.028

Cited by 23 publications

(2 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Moreover, for this reason, information about treatment at discharge other than antiplatelets and statins is not available in our study. Finally, conditions with prognostic impact in elderly women with NSTEACS, such as frailty and other geriatric syndromes [36][37][38], were not included in our study. In spite of these limitations, and to the best of our knowledge, this is the first study addressing the impact of the interaction between sex and DM in the prognosis of elderly patients with NSTEACS.…”

Section: Discussionmentioning

confidence: 99%

Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome

Díez‐Villanueva

Garcı́a-Acuña

Raposeiras‐Roubín

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p < 0.001) and more often had a history of hypertension (77% vs. 83.1%, p < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78; p < 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14; p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.

show abstract

Section: Discussionmentioning

confidence: 99%

Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome

Díez‐Villanueva

Garcı́a-Acuña

Raposeiras‐Roubín

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

show abstract

“…Other observational data suggest the opposite, finding a better outcome in frail patients with non-ST elevation acute coronary syndrome when treated with PCI [76]. An ongoing clinical trial (The Invasive and Conservative Strategies in Elderly Frail Patients with Non-STEMI, NCT03208153) that randomizes frail patients older than 70 years to a routine invasive vs. conservative (selective invasive) strategy will shed light on this matter [82].…”

Section: Geriatric Conditions: Frailty and Comorbiditymentioning

confidence: 99%

Acute Coronary Syndrome in the Older Patient

García‐Blas

Cordero

Díez‐Villanueva

et al. 2021

JCM

Self Cite

View full text Add to dashboard Cite

Coronary artery disease is one of the leading causes of morbidity and mortality, and its prevalence increases with age. The growing number of older patients and their differential characteristics make its management a challenge in clinical practice. The aim of this review is to summarize the state-of-the-art in diagnosis and treatment of acute coronary syndromes in this subgroup of patients. This comprises peculiarities of ST-segment elevation myocardial infarction (STEMI) management, updated evidence of non-STEMI therapeutic strategies, individualization of antiplatelet treatment (weighting ischemic and hemorrhagic risks), as well as assessment of geriatric conditions and ethical issues in decision making.

show abstract

Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non–ST-Segment Elevation Acute Myocardial Infarction

et al. 2023

Self Cite

View full text Add to dashboard Cite

ImportanceTo our knowledge, no randomized clinical trial has compared the invasive and conservative strategies in frail, older patients with non–ST-segment elevation acute myocardial infarction (NSTEMI).ObjectiveTo compare outcomes of invasive and conservative strategies in frail, older patients with NSTEMI at 1 year.Design, Setting, and ParticipantsThis multicenter randomized clinical trial was conducted at 13 Spanish hospitals between July 7, 2017, and January 9, 2021, and included 167 older adult (≥70 years) patients with frailty (Clinical Frailty Scale score ≥4) and NSTEMI. Data analysis was performed from April 2022 to June 2022.InterventionsPatients were randomized to routine invasive (coronary angiography and revascularization if feasible; n = 84) or conservative (medical treatment with coronary angiography for recurrent ischemia; n = 83) strategy.Main Outcomes and MeasuresThe primary end point was the number of days alive and out of the hospital (DAOH) from discharge to 1 year. The coprimary end point was the composite of cardiac death, reinfarction, or postdischarge revascularization.ResultsThe study was prematurely stopped due to the COVID-19 pandemic when 95% of the calculated sample size had been enrolled. Among the 167 patients included, the mean (SD) age was 86 (5) years, and mean (SD) Clinical Frailty Scale score was 5 (1). While not statistically different, DAOH were about 1 month (28 days; 95% CI, −7 to 62) greater for patients managed conservatively (312 days; 95% CI, 289 to 335) vs patients managed invasively (284 days; 95% CI, 255 to 311; P = .12). A sensitivity analysis stratified by sex did not show differences. In addition, we found no differences in all-cause mortality (hazard ratio, 1.45; 95% CI, 0.74-2.85; P = .28). There was a 28-day shorter survival in the invasive vs conservatively managed group (95% CI, −63 to 7 days; restricted mean survival time analysis). Noncardiac reasons accounted for 56% of the readmissions. There were no differences in the number of readmissions or days spent in the hospital after discharge between groups. Neither were there differences in the coprimary end point of ischemic cardiac events (subdistribution hazard ratio, 0.92; 95% CI, 0.54-1.57; P = .78).Conclusions and RelevanceIn this randomized clinical trial of NSTEMI in frail older patients, there was no benefit to a routine invasive strategy in DAOH during the first year. Based on these findings, a policy of medical management and watchful observation is recommended for older patients with frailty and NSTEMI.Trial RegistrationClinicalTrials.gov Identifier: NCT03208153

show abstract

Estrategia invasiva frente a conservadora en pacientes frágiles con IAMSEST. Diseño del ensayo clínico MOSCA-FRAIL

Cited by 23 publications

References 27 publications

Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome

Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome

Acute Coronary Syndrome in the Older Patient

Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non–ST-Segment Elevation Acute Myocardial Infarction

Contact Info

Product

Resources

About