Nuccia Morici1, Stefano Savonitto2, Luca A Ferri3, Daniele Grosseto4, Irene Bossi5, Paolo Sganzerla6, Giovanni Tortorella7, Michele Cacucci8, Maurizio Ferrario9, Gabriele Crimi9, Ernesto Murena10, Stefano Tondi11, Anna Toso12, Nicola Gandolfo13, Amelia Ravera14, Elena Corrada15, Matteo Mariani16, Leonardo Di Ascenzo17, A Sonia Petronio18, Claudio Cavallini19, Giancarlo Vitrella20, Roberto Antonicelli21, Federico Piscione22, Renata Rogacka23, Laura Antolini24, Gianfranco Alicandro25, Carlo La Vecchia25, Luigi Piatti3, Stefano De Servi26. 1. Unità di Cure Intensive Cardiologiche; ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy; Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milano, Italy. 2. Division of Cardiology, Ospedale Manzoni, Lecco, Italy. Electronic address: s.savonitto@asst-lecco.it. 3. Division of Cardiology, Ospedale Manzoni, Lecco, Italy. 4. Division of Cardiology, Ospedale Infermi, Rimini, Italy. 5. Unità di Cure Intensive Cardiologiche; ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy. 6. Division of Cardiology, ASST Bergamo ovest-ospedale di Treviglio, Treviglio, Italy. 7. Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy. 8. Division of Cardiology, Ospedale Maggiore, Crema, Italy. 9. Division of Cardiology, Fondazione IRCCS Policlinico S. Matteo, Pavia, Italy. 10. Division of Cardiology, Ospedale S. Maria delle Grazie, Pozzuoli, Italy. 11. Division of Cardiology, Ospedale Baggiovara, Modena, Italy. 12. Division of Cardiology, Ospedale S. Stefano, Prato, Italy. 13. Division of Cardiology, Ospedale Mauriziano, Torino, Italy. 14. Division of Cardiology, Ospedale Ruggi D' Aragona, Salerno, Italy. 15. Cardiovascular Department, Humanitas Research Hospital, Rozzano, Italy. 16. Division of Cardiology, Ospedale Civile, Legnano, Italy. 17. Division of Cardiology, Ospedale di San Donà di Piave-Portogruaro, Portogruaro, Italy. 18. Cardiothoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy. 19. Division of Cardiology, Ospedale S. Maria della Misericordia, Perugia, Italy. 20. Division of Cardiology, Ospedali Riuniti di Trieste, Trieste, Italy. 21. Division of Cardiology, INRCA-IRCCS, Ancona, Italy. 22. Department of Medicine, Surgery and Dentistry, University of Salerno, Schola Medica Salernitana, Salerno, Italy. 23. Division of Cardiology, Ospedale di Desio, Desio, Italy. 24. School of Medicine, Center of Biostatistics for Clinical Epidemiology, University Milano Bicocca, Monza, Italy. 25. Department of Clinical Sciences and Community Health Università degli Studi di Milano, Milano, Italy. 26. Department of Cardiology, Multimedica IRCSS, Milan, Italy.
Abstract
INTRODUCTION: Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far. METHODS: Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke. RESULTS: Of 1443 ACS patients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P < .001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7). CONCLUSIONS: Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.
INTRODUCTION: Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome elderly patients undergoing percutaneous coronary intervention during index admission has not been published so far. METHODS: Retrospective cohort study of patients enrolled in the Elderly ACS-2 multicenter randomized trial. Main outcome measures were crude cumulative incidence and cause-specific hazard ratio (cHR) of cardiovascular death, noncardiovascular death, reinfarction, and stroke. RESULTS: Of 1443 ACSpatients aged >75 years (median age 80 years, interquartile range 77-84), 41% were classified as ST-elevation myocardial infarction (STEMI), and 59% had non-ST-elevation ACS (NSTEACS) (48% NSTEMI and 11% unstable angina). As compared with those with NSTEACS, STEMI patients had more favorable baseline risk factors, fewer prior cardiovascular events, and less severe coronary disease, but lower ejection fraction (45% vs 50%, P < .001). At a median follow-up of 12 months, 51 (8.6%) STEMI patients had died, vs 39 (4.6%) NSTEACS patients. After adjusting for sex, age, and previous myocardial infarction, the hazard among the STEMI group was significantly higher for cardiovascular death (cHR 1.85; 95% confidence interval [CI], 1.02-3.36), noncardiovascular death (cHR 2.10; 95% CI, 1.01-4.38), and stroke (cHR 4.8; 95% CI, 1.7-13.7). CONCLUSIONS: Despite more favorable baseline characteristics, elderly STEMI patients have worse survival and a higher risk of stroke compared with NSTEACS patients after percutaneous coronary intervention.
Authors: Nuccia Morici; Gianfranco Alicandro; Luca A Ferri; Luigi Piatti; Daniele Grosseto; Paolo Sganzerla; Giovanni Tortorella; Maurizio Ferrario; Gabriele Crimi; Irene Bossi; Stefano Tondi; Anna Sonia Petronio; Matteo Mariani; Anna Toso; Amelia Ravera; Elena Corrada; Davide Cao; Leonardo Di Ascenzo; Carlo La Vecchia; Stefano De Servi; Stefano Savonitto Journal: CJC Open Date: 2020-03-20
Authors: Christos Rammos; Aristotelis Kontogiannis; Amir A Mahabadi; Martin Steinmetz; Daniel Messiha; Julia Lortz; Tienush Rassaf Journal: BMC Cardiovasc Disord Date: 2021-08-02 Impact factor: 2.298