Octogenarian women with acute coronary syndrome present frailty and readmissions more frequently than men

Vicent, Lourdes; Arizá-Solé, Albert; Alegre, Oriol; Sanchis, Juan; López-Palop, Ramón; Formiga, Francesç; González-Salvado, Violeta; Bueno, Héctor; Vidán, María Teresa; Díez‐Villanueva, Pablo; Abu‐Assi, Emad; Martínez‐Sellés, Manuel

doi:10.1177/2048872618798226

Cited by 27 publications

(26 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Recently, we and other investigators have shown that frailty status is associated with inhospital and mid-term mortality in patients with acute coronary syndrome. 9,15,16 However, there have been few reports about changes in frailty status, which we addressed in this study. This study demonstrated that more than 40% of nonagenarians with AMI undergoing PCI were frail at admission and the proportion of patients with frailty clearly increased during hospitalisation.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical outcomes of nonagenarians with acute myocardial infarction who undergo percutaneous coronary intervention

Nishihira

Watanabe

Kuriyama

et al. 2020

European Heart Journal. Acute Cardiovascular Care

View full text Add to dashboard Cite

Background With increases in life expectancy, percutaneous coronary intervention is being performed more often, even in elderly patients with acute myocardial infarction. However, the optimal management of nonagenarians with acute myocardial infarction is uncertain. This study sought to investigate clinical outcomes of nonagenarians who undergo percutaneous coronary intervention. Methods Of 2640 consecutive patients with acute myocardial infarction hospitalised within 24 hours after symptom onset in 2009–2018, we prospectively analysed 96 nonagenarians (median age 92 years; interquartile range 91–94) who underwent percutaneous coronary intervention. Results The median follow-up period was 375 days. Inhospital major bleeding (Bleeding Academic Research Consortium type 3 or 5) and inhospital death occurred in 15.6% and 17.7% of patients, respectively. The proportion of patients with frailty increased during hospitalisation, from 43.8% (mild frailty 37.5%; moderate to severe frailty 6.3%) at admission to 60.7% (mild frailty 46.8%; moderate to severe frailty 13.9%) at discharge ( P < 0.01). The cumulative incidence of all-cause mortality was 22.2% at 180 days and 27.5% at 365 days. After adjusting for confounders, cardiogenic shock (hazard ratio (HR) 2.85; 95% confidence interval (CI) 1.07–7.64) and final thrombolysis in myocardial infarction flow grade less than 3 (HR 2.45; 95% CI 1.03–5.58) were associated with higher mid-term mortality and cardiac rehabilitation (HR 0.25; 95% CI, 0.13–0.50) was associated with lower mid-term mortality. Conclusions The mid-term mortality of selected nonagenarians with acute myocardial infarction who undergo percutaneous coronary intervention is reasonable, but older patients have high rates of inhospital major bleeding and progression of frailty. This study provides physicians, patients and families with important information for therapeutic decision-making.

show abstract

Section: Discussionmentioning

confidence: 99%

“…Overall, inhospital major bleeding and inhospital death occurred in 15.6% (BARC type 3 11.4%; BARC type 5 4.2%) and 17.7% (cardiac death 16.7%; non-cardiac death 1.0%) of patients, respectively ( Figure 2(a)). The median duration of hospitalisation was 15.5 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21) days.…”

Section: Inhospital Outcomesmentioning

confidence: 99%

Clinical outcomes of nonagenarians with acute myocardial infarction who undergo percutaneous coronary intervention

Nishihira

Watanabe

Kuriyama

et al. 2020

European Heart Journal. Acute Cardiovascular Care

View full text Add to dashboard Cite

show abstract

“…Finally, Vicent, et al (60) in an octogenarian Spanish population of 535 patients with STEMI found that female sex was independently associated with death and hospitalisation at 6-month follow-up.…”

Section: Myocardial Infarction With Non-obstructed Coronary Arteriesmentioning

confidence: 94%

The year in cardiology: acute coronary syndromes

Banning¹,

Crea

Lüscher

2020

SAHJ

View full text Add to dashboard Cite

show abstract

“…Moreover, a third of patients with ACS are frail and a quarter of those ≥75 years are severely frail 16. Female sex independently predicts frailty among elderly patients with ACS, and frail women are at high risk of death despite ACS treatment 17…”

Section: Age At Disease Manifestation and Risk Profilementioning

confidence: 99%

Coronary artery disease and acute coronary syndrome in women

Mehilli

Presbitero²

2020

Heart

View full text Add to dashboard Cite

There are important dissimilarities in clinical presentation, aggregation of comorbidities, cardiovascular risk factors and the quality of delivery of medical care among men and women with acute coronary syndrome (ACS). Compared with men, despite the well-known older age and more pronounced frailty, women with ACS present later from symptom onset and are at high bleeding risk after invasive procedures. In addition, autoimmune/inflammatory disease, fibromuscular dysplasia, polycystic ovary, early menopause and history of pre-eclampsia are risk factors preceding ACS among younger women. They more often experience myocardial infarction in the absence of obstructive coronary arteries (MINOCA), which makes diagnosis and treatment of ACS among women more challenging compared with men. Women and men do both benefit from guideline-recommended treatment, although, compared with men, women with ACS have a higher adjusted risk of early death, which equalises between both sexes within the first year. Young women with ACS suffer frequently of depression and present often with MINOCA. Compared with young men, they (young women) have a higher risk of death. Therefore, focusing on young patients with ACS, understanding the particular physiopathology of MINOCA and developing programmes targeting comorbidities and depression-related behavioural risk factors are urgently needed.

show abstract

Octogenarian women with acute coronary syndrome present frailty and readmissions more frequently than men

Abstract: In octogenarians with acute coronary syndrome female sex was independently associated with death/hospitalisation at 6 months. Frailty was more common in women and was a predictor of poor prognosis. In men prefrailty also predicted a poor prognosis.

Cited by 27 publications

References 31 publications

Clinical outcomes of nonagenarians with acute myocardial infarction who undergo percutaneous coronary intervention

Clinical outcomes of nonagenarians with acute myocardial infarction who undergo percutaneous coronary intervention

The year in cardiology: acute coronary syndromes

Coronary artery disease and acute coronary syndrome in women

Contact Info

Product

Resources

About