Intervenção coronária percutânea em idosos: impacto da faixa etária mais avançada (> 80 Anos) no perfil clínico e nos resultados imediatos

Abstract

Percutaneous Coronary Intervention in the Elderly: Impact of Advanced Age (> 80 Years) on the Clinical Profile and Immediate Results Background: With the increase in longevity observed in the last decades, percutaneous coronary interventions (PCI) in octogenarians are increasingly recommended. However, they may not achieve the same results observed for younger elderly individuals. This study compared the profiles and immediate results of elderly patients > 80 and < 80 years of age. Methods: We performed a retrospective cohort study including 998 elderly patients treated from 2008 to 2010 at the Instituto Dante Pazzanese de Cardiologia, divided into two groups: group A, 192 (19.2%) octogenarians; and group B, 806 (81.8%) individuals with ages ranging from 70 to 79 years. Patients with clinical and angiographic indications for PCI were included according to the current guidelines. Results: Group A patients had a significant prevalence of chronic renal failure (78.6% vs. 54.8%; P < 0.01) and had a trend towards acute coronary syndrome (33.3% vs. 26.6%; P = 0.07). Type B2/C target lesions were also more frequent in group A (54.8% vs. 41.2%; P < 0.01), however, despite of these findings, these patients received less drug-eluting stents (18.1% vs. 31.2%; P < 0.01). There was no difference in mortality (0 vs 0.2%; P = 0.88) or in the rate of procedure-related myocardial infarction (5.7% vs. 3.3%; P = 0.18). Emergency CABG was not required in any of the patients. Conclusions: Octogenarians, who currently account for about 20% of the patients treated by PCI, had higher clinical and angiographic complexity, received less drug-eluting stents and had similar in-hospital results to the younger elderly individuals. KEY-WORDS:Angioplasty. Drug-eluting stents. Coronary disease. Aged. Aged, 80 and over.

Impacto da utilização do acesso radial na ocorrência de sangramento grave entre idosos submetidos a intervenção coronária percutânea

“…1 Advanced age is an important predisposing risk factor for severe bleeding due to the greater incidence of coexisting diffuse vascular disease, vessel injury, and clinical comorbidities. 2,3 Additionally, vascular complications related to arterial access represent an important site of bleeding among patients undergoing invasive coronary procedures.…”

Procedimentos cirúrgicos e idosos longevos: Revisão da literatura

“…Atualmente, os avanços nos cuidados trans-e pós-operatórios possibilitam resultados promissores em relação à morbidade e mortalidade de idosos tratados cirurgicamente (Alexandre, et al, 2012). Ao mesmo tempo, ocorreram vários fatores que contribuíram para aumentar as possibilidades de tratamento cirúrgico com maior efetividade como: revolução tecnológica nos materiais utilizados, aprimoramento da técnica cirúrgica, das drogas anestésicas, critérios rigorosos na seleção dos candidatos, cuidados de fatores de riscos pré-operatórios, procedimentos minimamente invasivos no perioperatório e cuidados intensivos no período pós-operatório (Alexandre, et al, 2012;Kroll, et al, 2011).…”