Myocardial Infarction in Centenarians. Data from The Polish Registry of Acute Coronary Syndromes

Piegza, Jacek; Poloński, Lech; Desperak, Aneta; Wester, Andrzej; Janion, Marianna; Mazurek, W; Wojakowski, Wojciech; Witkowski, Adam; Dudek, Dariusz; Gąsior, Mariusz

doi:10.3390/jcm9103377

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…A study in Poland also demonstrated the benefit of invasive therapy in patients over 100 years of age (Piegza et al, 2020).…”

Section: Discussionmentioning

confidence: 96%

ST-elevation Myocardial Infarction in Over 100 Years Old Patient: What is The Better Option

Isaridha¹,

Pikir²

2021

IJRP

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Background: Optimal therapy in ST-elevation myocardial infarction (STEMI) patients with extreme age is still a challenge. The presence of comorbidities and multiorgan dysfunction simultaneously increases the risk of ischemia and bleeding. Unfortunately, there are no adequate data for the benefit and reliability of the treatment in elderly patients. Case Summary: We report a case of a 103-year-old patient with substernal chest pain 6 hours before admission. His medical history was unremarkable. The physical examination revealed irregularly irregular pulse. An electrocardiogram showed atrial fibrillation with a moderate ventricular response with ST-elevation and Q waves in inferior lead. The patient was treated conservatively with dual antiplatelet aspirin and clopidogrel, and anticoagulated with fondaparinux. Although medical management was carried out because of family concerns, the best choice of therapy for STEMI patients of extreme ages was still a question. Discussion: Current practice guidelines recommend primary percutaneous coronary intervention as therapy of choice in STEMI patients with no upper age limit, and to start dual antiplatelet therapy using aspirin and a P2Y12 receptor blocker in all patients including the elderly. In a patient with atrial fibrillation, a shorter duration of dual antiplatelet therapy is recommended. Data regarding reperfusion therapy with the best level of efficacy and safety in this group is limited. Trials comparing various treatment strategies with oral anticoagulants are designed to investigate the safety, rather than efficacy. Another option to use single antiplatelet therapy to minimize bleeding risk still has limited data.

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“…A study in Poland also demonstrated the benefit of invasive therapy in patients over 100 years of age (Piegza et al, 2020).…”

Section: Discussionmentioning

confidence: 96%

ST-elevation Myocardial Infarction in Over 100 Years Old Patient: What is The Better Option

Isaridha¹,

Pikir²

2021

IJRP

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“…Few studies have specifically address centenarians with ACS. The Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the ACC/AHA (American College of Cardiology/American Heart Association) Guidelines (CRUSADE) registry showed a poor prognosis for nonagenarians and even more so for centenarians [ 17 ] and data form the Polish Registry of ACS, including 104 centenarians with myocardial infarction, found an in-hospital mortality of nearly 35% and one-year mortality of 70% [ 18 ].…”

Section: Agementioning

confidence: 99%

Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction

Álvarez-Zaballos,

Juárez-Fernández,

Martínez-Sellés

2024

Rev. Cardiovasc. Med.

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With population aging and the subsequent accumulation of cardiovascular risk factors, a growing proportion of patients presenting with acute coronary syndrome (ACS) are octogenarian (aged between 80 and 89). The marked heterogeneity of this population is due to several factors like age, comorbidities, frailty, and other geriatric conditions. All these variables have a strong impact on outcomes. In addition, a high prevalence of multivessel disease, complex coronary anatomies, and peripheral arterial disease, increases the risk of invasive procedures in these patients. In advanced age, the type and duration of antithrombotic therapy need to be individualized according to bleeding risk. Although an invasive strategy for non-ST-segment elevation acute myocardial infarction (NSTEMI) is recommended for the general population, its need is not so clear in octogenarians. For instance, although frail patients could benefit from revascularization, their higher risk of complications might change the risk/benefit ratio. Age alone should not be the main factor to consider when deciding the type of strategy. The risk of futility needs to be taken into account and identification of risk factors for adverse outcomes, such as renal impairment, could help in the decision-making process. Finally, an initially selected conservative strategy should be open to a change to invasive management depending on the clinical course (recurrent angina, ventricular arrhythmias, heart failure). Further evidence, ideally from prospective randomized clinical trials is urgent, as the population keeps growing.

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“…Несмотря на относительно малое число пациентов старше 90 лет в популяции в целом, Jacek Piegza с соавт. [18] удалось изучить клинические особенности, тактику ведения и исходы у пациентов с ИМ старше 100 лет, которые составляли 0,02 % от зарегистрированной популяции в Польском регистре острых коронарных синдромов [19], являющемся основой для этого исследования. При анализе данной работы подъем сег-мента ST на ЭКГ был зарегистрирован у 51,9 % пациентов, отек легких -у 13,5 %, КШ -у 3,8 %.…”

Section: внутренние болезни Original Researchunclassified

Myocardial infarction in nonagenarians: peculiarities of the clinical course, management, outcomes

Pereverzeva¹,

Galas²,

Natalia³

et al. 2023

Medical news of the North Caucasus

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Проведен анализ особенностей клинического течения, диагностики, тактики ведения, лечения, а также исходов у пациентов-долгожителей (≥90 лет) с инфарктом миокарда (ИМ).В исследование включены 82 пациента в возрасте ≥90 лет, выписанных из двух кардиологических центров г. Рязани в период с 1 января 2015 года по 31 декабря 2020 года с диагнозом ИМ. Из них мужчин 23,2 % (19). Медиана возраста всех пациентов -91 (90; 93) год.Наиболее распространенными жалобами являлись слабость, ангинозные боли и одышка. У 42,7 % (35) пациентов на электрокардиограмме был зарегистрирован подъем сегмента ST. Тромболитическая терапия была проведена 2,4 % (2), стентированы 7,3 % (6) пациентов. Развитие осложнений ИМ наблюдалось у 80,5 % (66) пациентов. Внутригоспитальная летальность -40,2 % (33).Факторы, ассоциированные с меньшим риском смерти в стационаре -назначение ингибиторов ангиотензинпревращающего фермента и сартанов (относительный риск 0,13 при 95 % доверительном интервале от 0,04 до 0,46; р=0,002), ассоциированные с большим риском -развитие кардиогенного шока (относительный риск 4,67 при 95 % доверительном интервале от 1,27 до 17,13; р=0,02). Ключевые слова: инфаркт миокарда, долгожители, исходы, кардиогенный шок, чрескожное коронарное вмешательствоOur objective was to study and analyze the peculiarities of the clinical course, diagnosis, management, treatment and outcomes in nonagenarians (≥90 years) with myocardial infarction (MI).The research included 82 patients aged ≥90 years, who were discharged from two cardiological centres in Ryazan in the period from January 1, 2015 to December 31, 2020, with MI. 23.2 % of those patients was men (19). Median of all patients -91 (90; 93) years old.The most common complaints were: weakness, anginal pain and dyspnea. 42.7 % (35) of patients had the elevation of ST segment on the electrocardiogram. Thrombolytic therapy was performed in 2.4 % (2) of cases, coronary angiography in 8.5 % (7) of patients, and 7.3 % (6) patients were stent. The development of complications of myocardial infarction was observed in 80.5 % (66) of patients. Intrahospital mortality rate was 40.2 % (33).The factors associated with a lower risk of in-hospital death are the prescription of angiotensin-converting enzyme inhibitors and sartans (relative risk 0.13 with a 95 % confidence interval from 0.04 to 0.46; p=0.002), with a large risk of deathdevelopment of cardiogenic shock (relative risk 4.67 with a 95 % confidence interval from 1.27 to 17.13; p=0.02).

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Myocardial Infarction in Centenarians. Data from The Polish Registry of Acute Coronary Syndromes

Cited by 4 publications

References 23 publications

ST-elevation Myocardial Infarction in Over 100 Years Old Patient: What is The Better Option

ST-elevation Myocardial Infarction in Over 100 Years Old Patient: What is The Better Option

Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction

Myocardial infarction in nonagenarians: peculiarities of the clinical course, management, outcomes

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