Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS

Abstract

Background Whether very elderly women with acute coronary syndromes (ACS) should receive aggressive percutaneous coronary intervention (PCI) is still controversial. We assessed the effectiveness and long-term clinical outcomes of successful PCI in this population and identified prognostic factors which might contribute to the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the very elderly female PCI cohort. Methods Female ACS patients aged ≥ 80 years were consecutively enrolled (n = 729) into the study. All the patients were divided into female PCI group (n = 232) and medical group (n = 497). MACCE was followed up, including non-fatal myocardial infarction (MI), stroke, heart failure requiring hospitalization (HFRH), cardiovascular (CV) death, and the composite of them. After propensity score matching (1:1), the incidences of MACCE were compared between the two groups. Clinical and coronary artery lesion characteristics were compared between the female PCI patients with (n = 56) and without MACCE (n = 176). Multivariate Cox regression analysis was performed to identify risk factors which independently associated with MACCE in the female PCI patients. MACCE of male PCI patients, who aged ≥ 80 years and hospitalized in the same period (n = 264), was also compared with that of the female PCI patients. Results A total of 32% very elderly female ACS patients received PCI in the present study. (1) Compared to female medical group, PCI procedure significantly alleviated the risks of MACCE: non-fatal MI (6.2% vs. 20.2%, P < 0.001), HFRH (10.9% vs. 22.5%, P = 0.012), CV death (12.4% vs. 28.7%, P < 0.001) and the composite MACCE (24.0% vs. 44.2%, P < 0.001) during the median follow-up period of 36 months. (2) Between very elderly female and male PCI patients, there were no significant differences in occurrence of MACCE (P = 0.232) and CV death (P = 0.951). (3) Multivariate Cox analysis revealed that ST-segment elevation myocardial infarction (STEMI) (HR 1.944, 95% CI 1.11–3.403, P = 0.02) and elevated log- N-Terminal pro-brain natriuretic peptide (NT-proBNP) (HR 1.689, 95% CI 1.029–2.773, P = 0.038) were independently associated with the incidence of MACCE in the female PCI patients. Conclusions PCI procedure significantly attenuated the risk of MACCE and improved the long-term clinical outcomes in very elderly female ACS patients. Aggressive PCI strategy may be reasonable in this population.

Knowledge About the Stents and Post Pci Pharmacotherapy Among Patients Undergoing Pci

“…A large number of studies showed that there was a negative correlation between levels of knowledge and age with older people having being less knowledgeable than their younger counterparts. 1,5,7,9,11,15,16 However, there was no association that was found between age and dependent variable in our study.…”

“…At present, after stent the recurrence rate is well below 10%.With these improvements in the overall levels of safety and effectiveness of PCI, the number of procedures being carried out has seen an exponential increase with more than 90% of all PCI procedures involving at least one coronary stent. 4,5 It was in 1977 that the very first coronary balloon angioplasty was carried out by Andreas Gruentzigusing. Since the first time, this procedure has grown in use and been developed progressively with the advances in technology.…”

In-Hospital and Short-Term Outcomes of Percutaneous Coronary Intervention in Patients Older Than 65 Years Old: Results from Tanta PCI Registry

“…Those figures were better than those noticed in the study fulfilled by Kocayigit et al [18] in which 8.9% of primary PCI patients suffered ischaemic stroke. However, CVS figure (3.4%) in the study done by Wang et al [19] may be considered better than its counterpart in our study as its population was very elderly women >80 years of age.…”

“…This may be explained by the longest follow-up period ranging from 4 month to 2 years. [19] in which hospital stay ranged from six to ten days, with 7 days in average. This may be explained by the lower frequency of inhospital complications recorded in the current study, and the relative shortage of CCU beds indicating a more rapid cycle of admission and discharge of patients.…”

The Diagnostic Value of Combined Detection of Serum Lp-PLA2 and Hcy and Color Doppler in Elderly Patients with Acute Coronary Syndrome and Effect on Endothelial Function

“…At present, the most commonly used clinical diagnosis methods are color Doppler ultrasound diagnosis, CT, MRI diagnosis, and blood index testing, among which color Doppler ultrasound diagnosis is the simplest and fastest diagnosis method. Blood index testing facilitates the determination of related diseases by evaluation of the expression level of specific blood indices, which is associated with more accurate diagnostic results [21][22][23].…”