Outcomes of invasive treatment in very elderly Polish patients with non-ST-segment-elevation myocardial infarction from 2003&amp;#8211;2009 (from the PL-ACS registry)

Janion−Sadowska

et al. 2020

pwki

Self Cite

A b s t r a c t Introduction: Dynamic changes both in clinical profile and treatment strategy of non ST-segment elevation myocardial infarction (NSTEMI) patients have been observed recently. The exact impact of them on prognosis in a wide national population remains unclear.Aim: To evaluate the impact of treatment advances between 2005 and 2014 on the outcomes of NSTEMI cases. Material and methods: NSTEMI patients from the Polish Registry of Acute Coronary Syndromes (PL-ACS) were included to the analysis. The mortality rate in a hospital observation as well as in 12-month follow-up was evaluated.Results: The frequency of diabetes, hypertension, prior coronary artery interventions (especially percutaneous coronary intervention) raised. A frequency of invasive procedures increased remarkably (coronary angiography from 35.8% to 90.7%; p < 0.05 and percutaneous coronary intervention from 25.7% to 63.6%; p < 0.05). The usage of P2Y12 -inhibitors raised substantially from 56% to 93%; p < 0.05. In-hospital mortality decreased by fifty percent (in women from 6.6% to 3.3%; p < 0.001 and in men from 4.9% to 2.5%; p < 0.001, respectively). Similarly, 12-month mortality decreased up to one third (in women from 21.6% to 15.1%; p < 0.001 and in men from 17.8% to 12.8%; p < 0.001, respectively). Invasive strategy appeared to be the strongest factor decreasing mortality. Into in-hospital observation it reduces triple mortality risk whereas in 12-month follow up twice. Using propensity score matching analysis the impact of the treatment improvements on relative risk reduction was estimated on over 60%.Conclusions: In last decade the outcomes of NSTEMI in Poland improved substantially. The predominant impact on it had a routine invasive strategy. S u m m a r yDynamic changes both in clinical profile and treatment strategy of non ST-segment elevation myocardial infarction (NSTEMI) patients have been observed recently. The exact impact of them on prognosis in a wide national population remains unclear. NSTEMI patients from the Polish Registry of Acute Coronary Syndromes (PL-ACS) were included to the analysis. In-hospital mortality decreased by fifty percent (in women from 6.6% to 3.3%; p < 0.001 and in men from 4.9% to 2.5%; p < 0.001, respectively). Similarly, 12-month mortality decreased up to one third (in women from 21.6% to 15.1%; p < 0.001 and in men from 17.8% to 12.8%; p < 0.001, respectively). Invasive strategy appeared to be the strongest factor decreasing mortality. Into in-hospital observation it reduces triple mortality risk whereas in 12-month follow up twice. Using propensity score matching analysis the impact of the treatment improvements on relative risk reduction was estimated on over 60%.

“…Multivariable analysis confirmed the significant invasive strategy contribution to outcomes which appear to be continuously better than previously reported [4,9,15].…”

Section: Discussionsupporting

confidence: 65%

The progress in outcomes of the management of patients with non-ST-segment elevation myocardial infarction between 2005 and 2014 in Poland – a propensity score matching analysis from the PL-ACS registry

Janion−Sadowska

et al. 2020

pwki

Self Cite

“…Outcomes adjusted for confounding factors in propensity score analyses 18. The Polish Registry of Acute Coronary Syndromes (PL-ACS) enrolled patients in a nationwide, prospective study of consecutively hospitalised patients aged ≥80 years with NSTEMI in 2003–2009 19. The study reported outcomes for propensity matched subgroups.…”

Section: Resultsmentioning

confidence: 99%

Revascularisation compared with initial medical therapy for non-ST-elevation acute coronary syndromes in the elderly: a meta-analysis

Gnanenthiran

Kritharides

D’Souza³

et al. 2017

Heart

“…II). Similar factors, with the exception of hypertension, were more prevalent in the patients in our study than in individuals with STEMI [18] and in octogenarians with NSTEMI [19]. Compared with the historical control, the patients in our study with PAD with acute ischemic stroke [20] presented significantly more frequently with a smoking habit, dyslipidemia and past myocardial infarction (Tab.…”

Section: Resultsmentioning

confidence: 49%

“…The prevalence of respective atherosclerosis risk factors in comparison to the data from large epidemiological studies on Polish populations (POLSCREEN, 400 Towns Project, WOBASZ, NATPOL PLUS) [16], as well as a comparison of these risk factors to recent data concerning the frequency of atherosclerosis risk factors in patients with chronic coronary syndromes (POLSCREEN CAD) [16], acute coronary syndromes [17], both with sustained ST-segment elevation (STEMI) [18] and with non-sustained ST-segment elevation (NSTEMI) [19], in addition to acute cerebral manifestations of vascular disease (a large Polish study was not available) [20].…”

Section: Main Outcomes Measuredmentioning

confidence: 99%

Atherosclerosis risk factors in male patients qualified for percutaneous stenting of lower extremity arteries. A retrospective cohort study

Trofimiuk

Koza

Grzelązka

et al. 2016

MBS

S u m m a r y O b j e c t i v e s . Leg ischemia is the third leading cause of atherosclerotic cardiovascular morbidity, concerning about 20-30% of the elderly population. Recognition of its risk factors helps in early diagnosis and patient management. The aim of this study was to determine the prevalence of respective atherosclerosis risk factors among patients with peripheral artery disease (PAD) referred for lower limb endovascular revascularization and compare their prevalence with the data obtained in large epidemiological investigations and in patients with atherosclerosis manifestation in coronary and cerebral vascular beds. M a t e r i a l a n d m e t h o d s . Medical documentation for 73 male patients with PAD after a first endovascular intervention was evaluated retrospectively, and the prevalence of atherosclerosis risk factors found was compared with historical control groups from the literature. R e s u l t s . The patients studied presented significantly greater prevalence of a current smoking habit and diabetes mellitus than in the POLSCREEN, WOBASZ and NATPOL PLUS studies, significantly greater prevalence of hypertension than in WOBASZ and NATPOL PLUS, significantly greater prevalence of dyslipidemia than in POLSCREEN and NATPOL PLUS, significantly lower prevalence of BMI ≥ 25 kg/m 2 than in POLSCREEN, and greater than in NATPOL PLUS. In comparison to patients with coronary artery disease (CAD), individuals with PAD had a lower prevalence of hypertension and overweight and/or obesity, but greater occurrence of a current smoking habit and dyslipidemia. C o n c l u s i o n s . Patients with PAD who were qualified for endovascular therapy presented greater prevalence of atherosclerosis risk factors and multisite vascular disease manifestation than various general Polish populations and subjects with CAD, which suggests the need for the improved management of these patients.S t r e s z c z e n i e C e l e . Przewlekłe niedokrwienie kończyn dolnych (PNKD) jest trzecim, co do częstości, schorzeniem sercowonaczyniowym, dotyczącym około 20-30% dorosłej populacji. Określenie czynników ryzyka PNKD jest istotne dla wczesnej diagnozy i właściwego leczenia chorych. Celem pracy było porównanie częstości występowania poszczególnych czynników ryzyka u pacjentów leczonych wewnątrznaczyniowo z powodu PNKD z danymi