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Espejo T, Terhalle L, Malinovska A, Riedel HB, Arntz L, Hafner L, Delport-Lehnen K, Zuppinger J, Geigy N, Leuppi J, Somasundaram R, Bingisser R, Nickel CH. Diagnostic and prognostic value of cardiac troponins in emergency department patients presenting after a fall: A prospective, multicenter study. Acad Emerg Med 2024. [PMID: 38532263 DOI: 10.1111/acem.14897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/04/2024] [Accepted: 01/23/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Emergency department (ED) presentations after a ground-level fall (GLF) are common. Falls were suggested to be another possible presenting feature of a myocardial infarction (MI), as unrecognized MIs are common in older adults. Elevated high-sensitivity cardiac troponin (hs-cTn) concentrations could help determine the etiology of a GLF in ED. We investigated the prevalence of both MI and elevated high-sensitivity cardiac troponin T (hs-cTnT) and I (hs-cTnI), as well as the diagnostic accuracy of hs-cTnT and hs-cTnI regarding MI, and their prognostic value in older ED patients presenting after a GLF. METHODS This was a prospective, international, multicenter, cohort study with a follow-up of up to 1 year. Patients aged 65 years or older presenting to the ED after a GLF were prospectively enrolled. Two outcome assessors independently reviewed all discharge records to ascertain final gold standard diagnoses. Hs-cTnT and hs-cTnI levels were determined from thawed samples for every patient. RESULTS In total, 558 patients were included. Median (IQR) age was 83 (77-89) years, and 67.7% were female. Elevated hs-cTnT levels were found in 384 (68.8%) patients, and elevated hs-cTnI levels in 86 (15.4%) patients. Three patients (0.5%) were ascertained the gold standard diagnosis MI. Within 30 days, 18 (3.2%) patients had died. Nonsurvivors had higher hs-cTnT and hs-cTnI levels compared with survivors (hs-cTnT 40 [23-85] ng/L in nonsurvivors and 20 [13-33] ng/L in survivors; hs-cTnI 25 [14-54] ng/L in nonsurvivors and 8 [4-16] ng/L in survivors; p < 0.001 for both). CONCLUSIONS A majority of patients (n = 364, 68.8%) presenting to the ED after a fall had elevated hs-cTnT levels and 86 (15.4%) elevated hs-cTnI levels. However, the incidence of MI in these patients was low (n = 3, 0.5%). Our data do not support the opinion that falls may be a common presenting feature of MI. We discourage routine troponin testing in this population. However, hs-cTnT and hs-cTnI were both found to have prognostic properties for mortality prediction up to 1 year.
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Affiliation(s)
- Tanguy Espejo
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Lukas Terhalle
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandra Malinovska
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Henk B Riedel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Laura Arntz
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Livia Hafner
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Joanna Zuppinger
- Emergency Department, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Nicolas Geigy
- Emergency Department, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Jörg Leuppi
- Medical Faculty University of Basel and Cantonal Hospital Baselland, Liestal, Switzerland
| | - Rajan Somasundaram
- Department of Emergency Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christian H Nickel
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
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2
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Wang AZ, Hunter BR. Troponin or not troponin, what is the (clinical) question? Acad Emerg Med 2024. [PMID: 38511483 DOI: 10.1111/acem.14900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/22/2024]
Affiliation(s)
- Alfred Z Wang
- West Sound Emergency Physicians, Seattle, Washington, USA
| | - Benton R Hunter
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Nowak W, Kowalik I, Stępińska J. 'Evaluation of beta-2-microglobulin and neuron-specific enolase as prognostic factors in patients over 65 years of age with frailty syndrome hospitalized for acute coronary syndrome'. Coron Artery Dis 2024:00019501-990000000-00190. [PMID: 38411209 DOI: 10.1097/mca.0000000000001343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
BACKGROUND The aim of the study is to assess the value of beta-2-microglobulin (B2M) and neuron-specific enolase (NSE) as prognostic factors in the population of patients over 65 years of age with frailty hospitalized due to acute coronary syndrome (ACS). METHODS Patients aged ≥65 years with ACS were included. Assessment of frailty was carried out using the FRAIL scale. The measurement of NSE and B2M was carried out three times during hospitalization: (1) at the time of admission, (2) on the second day of hospitalization, (3) on the seventh day of hospitalization, or the day of discharge if it was before the seventh day. The primary endpoint was all-cause mortality, and the secondary endpoint was unscheduled rehospitalization. RESULTS Of the 127 patients, frailty was identified in 39.3%. Multivariate analysis of variance showed significantly higher levels of NSE (P = 0.012) and B2M (P < 0.001) in patients with frailty compared to the nonfrail group and significant changes in marker levels during hospitalization - decreased NSE (P < 0.001) and increased B2M levels (P < 0.001). Elevated B2M-1 level was an independent marker of the occurrence of frailty [odds ratio (OR), 1.98 (1.09-4.00); P = 0.044], and the optimal cutoff point for the diagnosis of frailty was 2.85 mg/l [area under the curve (AUC), 0.718 (0.632-0.795)] with sensitivity 52% and specificity 84.4% (P < 0.001). Elevated NSE-3 level was associated with all-cause mortality, and each 1 ng/ml increase in NSE-3 increased the risk of death by 1.07-fold [OR, 1.07 (1.03-1.10]). Meanwhile, elevated B2M-3 level was associated with unscheduled rehospitalization, and each 1 mg/l increase in B2M-3 increased the risk of unscheduled rehospitalization by 1.21-fold [OR, 1.21 (1.03-1.42)]. The Harrell's C-index for all-cause mortality was higher for NSE-3 [0.820 (95% confidence interval {CI}, 0.706-0.934)] compared to frailty assessed by the FRAIL scale [0.715 (95% CI, 0.580-0.850)], which means that additional NSE-3 assessment may improve the prediction of all-cause mortality. However, Uno's C-Statistic analysis showed that the difference was not statistically significant (Pr>chi-square 0.556). Harrell's C-index for unscheduled rehospitalization was higher for frailty assessed by the FRAIL scale compared to B2M-3. CONCLUSION Monitoring NSE and B2M marker levels in patients over 65 years of age with frailty and ACS does not provide additional benefits in terms of prognostic ability compared to tests assessing frailty. B2M, assessed upon hospital admission and monitoring NSE and B2M levels during hospitalization may be considered in the diagnosis of frailty and risk stratification in a group of patients for whom currently available frailty diagnostic tools cannot be used.
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Affiliation(s)
- Wojciech Nowak
- Department of Intensive Cardiac Therapy, National Institute of Cardiology
| | - Ilona Kowalik
- Clinical Research Support Center, National Institute of Cardiology, Warsaw, Poland
| | - Janina Stępińska
- Department of Intensive Cardiac Therapy, National Institute of Cardiology
- Department of Medical Communication, School of Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland
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Cordero A, Cid-Alvarez B, Monteiro P, García-Acuña JM, Gonçalves F, Escribano D, Trillo R, Alvarez-Alvarez B, Gonçalves L, Bertomeu-Gonzalez V, González-Juanatey JR. Applicability of the Zwolle score for selection of very high-risk ST-elevation myocardial infarction patients treated with primary angioplasty. Angiology 2024; 75:175-181. [PMID: 36408662 DOI: 10.1177/00033197221139915] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
The Zwolle risk score was designed to stratify in-hospital mortality risk of ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (pPCI) and for decision-making in the unit where patients are admitted. We assessed the accuracy of Zwolle risk score for in-hospital mortality estimation compared with the GRACE score in all patients (n = 4446) admitted for STEMI in 3 university hospitals. Only one fourth of the patients were classified as high-risk by the Zwolle risk score vs 60% by the GRACE score. In-hospital mortality was 10.6%. A statistically significant increase in in-hospital mortality, adjusted by age, gender, and revascularization, was observed with both scores. The assessment of the optimal cut-off points verified the accuracy of Zwolle score ≥4 as optimal threshold for high-risk categorization. In contrast, GRACE score ≥140 had very low specificity as well as percentage of patients correctly classified; GRACE score ≥175 was fairly better. The reclassification index of the Zwolle score after applying the GRACE score was 35.5%. Selection of high-risk STEMI patients treated with pPCI based on the Zwolle risk score has higher specificity than the GRACE score and might be useful in clinical practice.
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Affiliation(s)
- Alberto Cordero
- Cardiology Department, Hospital Universitario de San Juan Alicante, Spain
- Unidad de Investigación de Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Belén Cid-Alvarez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Pedro Monteiro
- Cardiology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - Jose M García-Acuña
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Fernando Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - David Escribano
- Cardiology Department, Hospital Universitario de San Juan Alicante, Spain
- Unidad de Investigación de Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Spain
| | - Ramiro Trillo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Belén Alvarez-Alvarez
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Lino Gonçalves
- Cardiology Department, Hospitais da Universidade de Coimbra, Coimbra, Portugal
| | - Vicente Bertomeu-Gonzalez
- Cardiology Department, Hospital Universitario de San Juan Alicante, Spain
- Unidad de Investigación de Cardiología, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO), Spain
| | - José R González-Juanatey
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
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Gorog DA, Ferreiro JL, Ahrens I, Ako J, Geisler T, Halvorsen S, Huber K, Jeong YH, Navarese EP, Rubboli A, Sibbing D, Siller-Matula JM, Storey RF, Tan JWC, Ten Berg JM, Valgimigli M, Vandenbriele C, Lip GYH. De-escalation or abbreviation of dual antiplatelet therapy in acute coronary syndromes and percutaneous coronary intervention: a Consensus Statement from an international expert panel on coronary thrombosis. Nat Rev Cardiol 2023; 20:830-844. [PMID: 37474795 DOI: 10.1038/s41569-023-00901-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 07/22/2023]
Abstract
Conventional dual antiplatelet therapy (DAPT) for patients with acute coronary syndromes undergoing percutaneous coronary intervention comprises aspirin with a potent P2Y purinoceptor 12 (P2Y12) inhibitor (prasugrel or ticagrelor) for 12 months. Although this approach reduces ischaemic risk, patients are exposed to a substantial risk of bleeding. Strategies to reduce bleeding include de-escalation of DAPT intensity (downgrading from potent P2Y12 inhibitor at conventional doses to either clopidogrel or reduced-dose prasugrel) or abbreviation of DAPT duration. Either strategy requires assessment of the ischaemic and bleeding risks of each individual. De-escalation of DAPT intensity can reduce bleeding without increasing ischaemic events and can be guided by platelet function testing or genotyping. Abbreviation of DAPT duration after 1-6 months, followed by monotherapy with aspirin or a P2Y12 inhibitor, reduces bleeding without an increase in ischaemic events in patients at high bleeding risk, particularly those without high ischaemic risk. However, these two strategies have not yet been compared in a head-to-head clinical trial. In this Consensus Statement, we summarize the evidence base for these treatment approaches, provide guidance on the assessment of ischaemic and bleeding risks, and provide consensus statements from an international panel of experts to help clinicians to optimize these DAPT approaches for individual patients to improve outcomes.
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Affiliation(s)
- Diana A Gorog
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, UK.
- Centre for Health Services Research, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.
| | - Jose Luis Ferreiro
- Department of Cardiology, Hospital Universitario de Bellvitge, CIBERCV, L'Hospitalet de Llobregat, Spain
- Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital Cologne, Academic Teaching Hospital University of Cologne, Cologne, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan
| | - Tobias Geisler
- Department of Cardiology and Angiology, University Hospital, Eberhard-Karls-University Tuebingen, Tuebingen, Germany
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Kurt Huber
- 3rd Department of Medicine, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria
- Medical Faculty, Sigmund Freud University, Vienna, Austria
| | - Young-Hoon Jeong
- CAU Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, Republic of Korea
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Eliano P Navarese
- Interventional Cardiology and Cardiovascular Medicine Research, Department of Cardiology and Internal Medicine, Nicolaus Copernicus University, Bydgoszcz, Poland
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Andrea Rubboli
- Department of Emergency, Internal Medicine and Cardiology, Division of Cardiology, S. Maria delle Croci Hospital, Ravenna, Italy
| | - Dirk Sibbing
- Ludwig-Maximilians University München, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), partner site Munich Heart Alliance, Munich, Germany
- Privatklinik Lauterbacher Mühle am Ostsee, Seeshaupt, Germany
| | | | - Robert F Storey
- Cardiovascular Research Unit, Department of Infection, Immunity & Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Jack W C Tan
- National Heart Centre Singapore and Sengkang General Hospital, Singapore, Singapore
| | - Jurrien M Ten Berg
- St Antonius Hospital, Nieuwegein, The Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Marco Valgimigli
- Cardiocentro Institute, Ente Ospedaliero Cantonale, Università della Svizzera Italiana (USI), Lugano, Switzerland
- University of Bern, Bern, Switzerland
| | | | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool, UK
- Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Marcos-Garcés V, Merenciano-González H, Gavara J, Gabaldón-Pérez A, López-Lereu MP, Monmeneu JV, Nuñez J, Pérez N, Ríos-Navarro C, de Dios E, Chorro FJ, Valente F, Lorenzatti D, Domenech-Ximenos B, Alonso Tello A, Maymí-Ballesteros M, Rello-Sabaté P, Morr CI, Ortiz-Pérez JT, Rodríguez-Palomares JF, Bodí V. MRI Investigation of the Differential Impact of Left Ventricular Ejection Fraction After Myocardial Infarction in Elderly vs. Nonelderly Patients to Predict Readmission for Heart Failure. J Magn Reson Imaging 2023; 58:1507-1518. [PMID: 36748793 DOI: 10.1002/jmri.28632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/23/2023] [Accepted: 01/23/2023] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients with ST-segment elevation myocardial infarction (STEMI), especially elderly individuals, have an increased risk of readmission for acute heart failure (AHF). PURPOSE To study the impact of left ventricular ejection fraction (LVEF) by MRI to predict AHF in elderly (>70 years) and nonelderly patients after STEMI. STUDY TYPE Prospective. POPULATION Multicenter registry of 759 reperfused STEMI patients (23.3% elderly). FIELD STRENGTH/SEQUENCE 1.5-T. Balanced steady-state free precession (cine imaging) and segmented inversion recovery steady-state free precession (late gadolinium enhancement) sequences. ASSESSMENT One-week MRI-derived LVEF (%) was quantified. Sequential MRI data were recorded in 579 patients. Patients were categorized according to their MRI-derived LVEF as preserved (p-LVEF, ≥50%), mildly reduced (mr-LVEF, 41%-49%), or reduced (r-LVEF, ≤40%). Median follow-up was 5 [2.33-7.54] years. STATISTICAL TESTS Univariable (Student's t, Mann-Whitney U, chi-square, and Fisher's exact tests) and multivariable (Cox proportional hazard regression) comparisons and continuous-time multistate Markov model to analyze transitions between LVEF categories and to AHF. Hazard ratios (HR) with 95% confidence intervals (CIs) were computed. P < 0.05 was considered statistically significant. RESULTS Over the follow-up period, 79 (10.4%) patients presented AHF. MRI-LVEF was the most robust predictor in nonelderly (HR 0.94 [0.91-0.98]) and elderly patients (HR 0.94 [0.91-0.97]). Elderly patients had an increased AHF risk across the LVEF spectrum. An excess of risk (compared to p-LVEF) was noted in patients with r-LVEF both in nonelderly (HR 11.25 [5.67-22.32]) and elderly patients (HR 7.55 [3.29-17.34]). However, the mr-LVEF category was associated with increased AHF risk only in elderly patients (HR 3.66 [1.54-8.68]). Less transitions to higher LVEF states (n = 19, 30.2% vs. n = 98, 53%) and more transitions to AHF state (n = 34, 53.9% vs. n = 45, 24.3%) were observed in elderly than nonelderly patients. DATA CONCLUSION MRI-derived p-LVEF confers a favorable prognosis and r-LVEF identifies individuals at the highest risk of AHF in both elderly and nonelderly patients. Nevertheless, an excess of risk was also found in the mr-LVEF category in the elderly group. EVIDENCE LEVEL 2. TECHNICAL EFFICACY Stage 2.
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Affiliation(s)
- Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - Héctor Merenciano-González
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - José Gavara
- INCLIVA Health Research Institute, Valencia, Spain
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain
| | - Ana Gabaldón-Pérez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
| | - María P López-Lereu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, Spain
| | - José V Monmeneu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, Spain
| | - Julio Nuñez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Nerea Pérez
- INCLIVA Health Research Institute, Valencia, Spain
| | | | - Elena de Dios
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
| | - Filipa Valente
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - Daniel Lorenzatti
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Blanca Domenech-Ximenos
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Cardiothoracic Imaging -Diagnostic Imaging Center, Hospital Clínic, Barcelona, Spain
| | - Albert Alonso Tello
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | | | - Pau Rello-Sabaté
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain
| | - Carlos Igor Morr
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Jose T Ortiz-Pérez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
- Cardiovascular Institute, Hospital Clínic, Barcelona, Spain
| | - Jose F Rodríguez-Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vicente Bodí
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, Spain
- INCLIVA Health Research Institute, Valencia, Spain
- Faculty of Medicine and Odontology, University of Valencia, Valencia, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, Spain
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Choi Y, Lee H. Factors related to under-triage of patients with acute coronary syndrome in the emergency department: A retrospective study. Int Emerg Nurs 2023; 69:101316. [PMID: 37348241 DOI: 10.1016/j.ienj.2023.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 05/13/2023] [Accepted: 05/31/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION This study aimed to provide fundamental data to avoid under-triage in the initial severity classification of patients with suspected acute coronary syndrome (ACS) by analyzing factors associated with patients who visited the emergency department (ED). METHODS This retrospective study identified factors related to under-triage by comparing the characteristics of participants diagnosed with ACS and appropriately classified those who were under-triaged. RESULTS The probability of under-triage increased 5.402 times in patients who visited the ED immediately than in those who visited the ED through an outpatient clinic. The probability of under-triage decreased in patients who visited the ED by ambulance rather than using their personal vehicle. Furthermore, when patients experienced chest pain, the tendency for under-triage decreased. The under-triage tendency increased 8.315 times in patients with dementia. CONCLUSIONS Medical staff training on the classification of non-specific symptoms accompanying diseases is needed. Patients with ACS need to be aware of the symptoms that require visiting the ED and the appropriate route and method. Therefore, it is possible to avoid under-triage for possible ACS during the initial triage, and triage can be performed quickly and accurately.
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Affiliation(s)
- Yeonghwan Choi
- Emergency Medical Center, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Hyeongsuk Lee
- College of Nursing, Gachon University, Incheon, South Korea.
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De Servi S, Landi A, Savonitto S, Morici N, De Luca L, Montalto C, Crimi G, De Rosa R, De Luca G. Antiplatelet Strategies for Older Patients with Acute Coronary Syndromes: Finding Directions in a Low-Evidence Field. J Clin Med 2023; 12:2082. [PMID: 36902869 PMCID: PMC10003933 DOI: 10.3390/jcm12052082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/23/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
Patients ≥ 75 years of age account for about one third of hospitalizations for acute coronary syndromes (ACS). Since the latest European Society of Cardiology guidelines recommend that older ACS patients use the same diagnostic and interventional strategies used by the younger ones, most elderly patients are currently treated invasively. Therefore, an appropriate dual antiplatelet therapy (DAPT) is indicated as part of the secondary prevention strategy to be implemented in such patients. The choice of the composition and duration of DAPT should be tailored on an individual basis, after careful assessment of the thrombotic and bleeding risk of each patient. Advanced age is a main risk factor for bleeding. Recent data show that in patients of high bleeding risk short DAPT (1 to 3 months) is associated with decreased bleeding complications and similar thrombotic events, as compared to standard 12-month DAPT. Clopidogrel seems the preferable P2Y12 inhibitor, due to a better safety profile than ticagrelor. When the bleeding risk is associated with a high thrombotic risk (a circumstance present in about two thirds of older ACS patients) it is important to tailor the treatment by taking into account the fact that the thrombotic risk is high during the first months after the index event and then wanes gradually over time, whereas the bleeding risk remains constant. Under these circumstances, a de-escalation strategy seems reasonable, starting with DAPT that includes aspirin and low-dose prasugrel (a more potent and reliable P2Y12 inhibitor than clopidogrel) then switching after 2-3 months to DAPT with aspirin and clopidogrel for up to 12 months.
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Affiliation(s)
- Stefano De Servi
- Department of Molecular Medicine, University of Pavia Medical School, 27100 Pavia, Italy
| | - Antonio Landi
- Division of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland
| | | | - Nuccia Morici
- IRCCS S. Maria Nascente—Fondazione Don Carlo Gnocchi ONLUS, 20148 Milan, Italy
| | - Leonardo De Luca
- Department of Cardiovascular Sciences, A.O. San Camillo-Forlanini, 00152 Roma, Italy
| | - Claudio Montalto
- Interventional Cardiology, De Gasperis Cardio Center, Niguarda Hospital, 20162 Milan, Italy
- Clinical and Interventional Cardiology, Istituto Clinico Sant’Ambrogio, Gruppo San Donato, 20122 Milan, Italy
| | - Gabriele Crimi
- Interventional Cardiology Unit, Cardio-Thoraco Vascular Department (DICATOV), IRCCS, Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Roberta De Rosa
- University Hospital San Giovanni di Dio e Ruggi d’Aragona, 84131 Salerno, Italy
- Goethe University Hospital Frankfurt, 60528 Frankfurt am Main, Germany
| | - Giuseppe De Luca
- Division of Cardiology, AOU “Policlinico G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, 98039 Messina, Italy
- Division of Cardiology, Nuovo Galeazzi-Sant’Ambrogio Hospital, 20161 Milan, Italy
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9
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Gabaldon-Perez A, Bonanad C, Garcia-Blas S, Marcos-Garcés V, D’Gregorio JG, Fernandez-Cisnal A, Valero E, Minana G, Merenciano-González H, Mollar A, Bodi V, Nunez J, Sanchis J. Clinical Predictors and Prognosis of Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA) without ST-Segment Elevation in Older Adults. J Clin Med 2023; 12:jcm12031181. [PMID: 36769828 PMCID: PMC9918164 DOI: 10.3390/jcm12031181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/28/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
A non-neglectable percentage of patients with non-ST elevation myocardial infarction (NSTEMI) show non-obstructive coronary arteries (MINOCA). Specific data in older patients are scarce. We aimed to identify the clinical predictors of MINOCA in older patients admitted for NSTEMI and to explore the long-term prognosis of MINOCA. This was a single-center, observational, consecutive cohort study of older (≥70 years) patients admitted for NSTEMI between 2010 and 2014 who underwent coronary angiography. Univariate and multivariate Cox regression were performed to analyze the association of variables with MINOCA and all-cause mortality and with major adverse cardiac events (MACE), defined as a combined endpoint of all-cause mortality and nonfatal myocardial infarction and a combined endpoint of cardiovascular mortality, nonfatal myocardial infarction, and unplanned revascularization. The registry included 324 patients (mean age 78.8 ± 5.4 years), of which 71 (21.9%) were diagnosed with MINOCA. Predictors of MINOCA were female sex, left bundle branch block, pacemaker rhythm, chest pain at rest, peak troponin level, previous MI, Killip ≥2, and ST segment depression. Regarding prognosis, patients with obstructive coronary arteries (stenosis ≥50%) and the subgroup of MINOCA patients with plaques <50% had a similar prognosis; while MINOCA patients with angiographically smooth coronary arteries had a reduced risk of MACE. We conclude that the following: (1) in elderly patients admitted for NSTEMI, certain universally available clinical, electrocardiographic, and analytical variables are associated with the diagnosis of MINOCA; (2) elderly patients with MINOCA have a better prognosis than those with obstructive coronary arteries; however, only those with angiographically smooth coronary arteries have a reduced risk of all-cause mortality and MACE.
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Affiliation(s)
- Ana Gabaldon-Perez
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
| | - Clara Bonanad
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Correspondence: ; Tel.: +34-961-973-500
| | - Sergio Garcia-Blas
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Víctor Marcos-Garcés
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
| | - Jessika Gonzalez D’Gregorio
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Agustín Fernandez-Cisnal
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Ernesto Valero
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Gema Minana
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Héctor Merenciano-González
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
| | - Anna Mollar
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Vicente Bodi
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Julio Nunez
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
| | - Juan Sanchis
- Cardiology Department, University Hospital Clinic of Valencia, 46010 Valencia, Spain
- INCLIVA Health Research Institute, 46010 Valencia, Spain
- Department of Medicine, Faculty of Medicine and Odontology, University of Valencia, 46010 Valencia, Spain
- Centro de Investigación Biomédica en Red—Cardiovascular (CIBER-CV), 28029 Madrid, Spain
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10
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[Primary percutaneous coronary intervention in centenarians: Time to be ready]. Rev Esp Geriatr Gerontol 2023; 58:46-48. [PMID: 36585311 DOI: 10.1016/j.regg.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/03/2022] [Accepted: 12/05/2022] [Indexed: 12/29/2022]
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11
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Li Y, Shen J, Hou X, Su Y, Jiao Y, Wang J, Liu H, Fu Z. Geriatric nutritional risk index predicts all-cause mortality in the oldest-old patients with acute coronary syndrome: A 10-year cohort study. Front Nutr 2023; 10:1129978. [PMID: 36960208 PMCID: PMC10027908 DOI: 10.3389/fnut.2023.1129978] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/14/2023] [Indexed: 03/09/2023] Open
Abstract
Background and objective Nutritional status assessment in acute coronary syndrome (ACS) patients has been neglected for a long time. The geriatric nutritional risk index (GNRI) is a sensitive indicator for assessing the nutritional status of the elderly. This study aims to explore the association between GNRI and all-cause mortality in the oldest-old patients with ACS. Methods The patients who met the inclusion criteria were consecutively enrolled from January 2006 to December 2012. Clinical data were collected on admission, and all subjects were followed after being discharged. The nutritional status was evaluated using GNRI. The relationship between GNRI and all-cause mortality was assessed by using different analyses. Results A total of 662 patients with a mean age of 81.87 ± 2.14 years old were included in our study, and followed (median: 63 months, IQR 51-71). Patients whose GNRI ≤ 98 were reported as at risk of malnutrition (31.11%, n = 206). In multivariable analysis, we found that for each SD increase in GNRI, the risk of all-cause mortality lowered by 23%, and the HR for GNRI ≤ 98 was 1.39 (95% CI 1.04-1.86). After stratifying patients into three groups by tertiles of GNRI, we found that the HRs for tertile 2 and tertile 3 were 1.49 (95% CI 1.02-2.19) and 1.74 (95% CI 1.22-2.50), respectively. The trend test revealed a dose-response relationship between GNRI and all-cause mortality in the oldest-old with ACS. Lastly, in subgroup analyses, we found a reliable association between GNRI and all-cause mortality. Conclusion Malnutrition is common in the oldest-old patients with ACS, and GNRI could predict their long-term all-cause mortality in a dose-dependent manner. GNRI may be a prospective index for risk-stratification and secondary-prevention in the oldest-old patients with ACS.
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Affiliation(s)
- Ying Li
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Jian Shen
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Xiaoling Hou
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | | | - Yang Jiao
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Jihang Wang
- Chinese PLA Medical School, Beijing, China
- Department of Cardiology, Hainan Hospital, Chinese PLA General Hospital, Sanya, China
| | - Henan Liu
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Zhenhong Fu
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
- *Correspondence: Zhenhong Fu,
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12
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Saada M, Kobo O, Polad J, Halabi M, IJsselmuiden AJJ, Puentes Á, Monségu J, Austin D, Baisebenov RK, Spanó F, Roguin A. Prognosis of PCI in AMI setting in the elderly population: Outcomes from the multicenter prospective e-ULTIMASTER registry. Clin Cardiol 2022; 45:1211-1219. [PMID: 36072999 DOI: 10.1002/clc.23902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Elderly patients with ST-elevation myocardial infarction (STEMI) who undergo percutaneous coronary intervention (PCI) are usually excluded from major trials. HYOPTHESIS This study sought to assess 1-year clinical outcomes following PCI with a drug-eluting stent in patients older than 80 years old with STEMI. METHODS The large all-comer, multicontinental e-ULTIMASTER registry included 7507 patients with STEMI who underwent PCI using the Ultimaster stent. The primary clinical endpoint was 1-year target lesion failure, a composite of cardiac death (CD), target vessel-related myocardial infarction (TV-MI), or clinically driven target lesion revascularization (CD-TLR). RESULTS There were 457 (6.1%) patients in the elderly group (≥80 years old) that were compared to 7050 (93.9%) patients <80 years. The elderly patients included more female patients and had significantly more comorbidities and had more complex coronary anatomy. The primary endpoint occurred in 7.2% of the elderly, compared to 3.1% of the younger group (p < .001). All-cause mortality was significantly higher among the elderly group compared to the younger group (10.1% vs. 2.3%, p < .0001), as well as CD (6.1% vs. 1.6%, p < .0001), but not TV-MI (1.1% vs. 0.7%, p = .34) or CD-TLR (1.1% vs. 1.4%, p = .63). CONCLUSION Elderly patients with STEMI presentation had a higher incidence of the composite endpoint than younger patients. All-cause and CD were higher for elderly patients compared to patients younger than 80 years old. However, there was no difference in the incidence of TV-MI or target lesion revascularizations. These findings suggest that PCI for STEMI in elderly patients is relatively safe.
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Affiliation(s)
- Majdi Saada
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
| | - Jawed Polad
- Department of Cardiology, Jeroen Bosch Ziekenhuis, 's Hertogenbosch, The Netherlands
| | - Majdi Halabi
- Department of Cardiology, Ziv Hospital, Safed, Israel
| | | | - Ángel Puentes
- Department of Cardiology, San Juan de Dios Hospital, Santiago, Chile
| | - Jacques Monségu
- Department of Cardiology, Groupe Hospitalier Mutualiste, Institut Cardiovasculaire, Grenoble, France
| | - David Austin
- Department of Cardiology, The James Cook University Hospital, Middlesbrough, UK
| | | | - Fabrizio Spanó
- Department of Cardiology, Meander Medical Center, Amersfoort, The Netherlands
| | - Ariel Roguin
- Department of Cardiology, Hillel Yaffe Medical Center, Technion-Faculty of Medicine, Hadera, Israel
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13
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Gabaldón-Pérez A, Marcos-Garcés V, Gavara J, López-Lereu MP, Monmeneu JV, Pérez N, Ríos-Navarro C, de Dios E, Merenciano-González H, Cànoves J, Racugno P, Bonanad C, Minana G, Núnez J, Moratal D, Chorro FJ, Valente F, Lorenzatti D, Ortiz-Pérez JT, Rodríguez-Palomares JF, Bodí V. Prognostic value of cardiac magnetic resonance early after ST-segment elevation myocardial infarction in older patients. Age Ageing 2022; 51:6847804. [PMID: 36436010 DOI: 10.1093/ageing/afac248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/05/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND older patients with ST-segment elevation myocardial infarction (STEMI) represent a very high-risk population. Data on the prognostic value of cardiac magnetic resonance (CMR) in this scenario are scarce. METHODS the registry comprised 247 STEMI patients over 70 years of age treated with percutaneous intervention and included in a multicenter registry. Baseline characteristics, echocardiographic parameters and CMR-derived left ventricular ejection fraction (LVEF, %), infarct size (% of left ventricular mass) and microvascular obstruction (MVO, number of segments) were prospectively collected. The additional prognostic power of CMR was assessed using adjusted C-statistic, net reclassification index (NRI) and integrated discrimination improvement index (IDI). RESULTS during a 4.8-year mean follow-up, the number of first major adverse cardiac events (MACE) was 66 (26.7%): 27 all-cause deaths and 39 re-admissions for acute heart failure. Predictors of MACE were GRACE score (HR 1.03 [1.02-1.04], P < 0.001), CMR-LVEF (HR 0.97 [0.95-0.99] per percent increase, P = 0.006) and MVO (HR 1.24 [1.09-1.4] per segment, P = 0.001). Adding CMR data significantly improved MACE prediction compared to the model with baseline and echocardiographic characteristics (C-statistic 0.759 [0.694-0.824] vs. 0.685 [0.613-0.756], NRI = 0.6, IDI = 0.08, P < 0.001). The best cut-offs for independent variables were GRACE score > 155, LVEF < 40% and MVO ≥ 2 segments. A simple score (0, 1, 2, 3) based on the number of altered factors accurately predicted the MACE per 100 person-years: 0.78, 5.53, 11.51 and 78.79, respectively (P < 0.001). CONCLUSIONS CMR data contribute valuable prognostic information in older patients submitted to undergo CMR soon after STEMI. The Older-STEMI-CMR score should be externally validated.
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Affiliation(s)
- Ana Gabaldón-Pérez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain
| | - Víctor Marcos-Garcés
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain
| | - José Gavara
- Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, 46022, Spain
| | - María P López-Lereu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, 46004, Spain
| | - José V Monmeneu
- Cardiovascular Magnetic Resonance Unit, ASCIRES Biomedical Group, Valencia, 46004, Spain
| | - Nerea Pérez
- Health Research Institute - INCLIVA, Valencia, 46010, Spain
| | | | - Elena de Dios
- Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain
| | - Héctor Merenciano-González
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain
| | - Joaquim Cànoves
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain
| | - Paolo Racugno
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain
| | - Clara Bonanad
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain
| | - Gema Minana
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, 28029, Spain
| | - Julio Núnez
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, 28029, Spain
| | - David Moratal
- Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, 46022, Spain
| | - Francisco J Chorro
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, 28029, Spain
| | - Filipa Valente
- Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, 08035, Spain
| | - Daniel Lorenzatti
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, 08036, Spain
| | - Jose T Ortiz-Pérez
- Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, 08036, Spain.,Cardiovascular Institute, Hospital Clínic, Barcelona, 08036, Spain
| | - Jose F Rodríguez-Palomares
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, 28029, Spain.,Hospital Universitari Vall d'Hebron, Department of Cardiology, Barcelona, 08035, Spain.,Vall d'Hebron Institut de Recerca (VHIR), Barcelona, 08035, Spain.,Universitat Autònoma de Barcelona, Barcelona, 08193, Spain
| | - Vicente Bodí
- Department of Cardiology, Hospital Clínico Universitario de Valencia, Valencia, 46010, Spain.,Health Research Institute - INCLIVA, Valencia, 46010, Spain.,Faculty of Medicine and Odontology, University of Valencia, Valencia, 46010, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBER-CV), Madrid, 28029, Spain
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14
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Relationships among social support, self-efficacy, and patient activation in community-dwelling older adults living with coronary heart disease: A cross-sectional study. Geriatr Nurs 2022; 48:139-144. [PMID: 36219932 DOI: 10.1016/j.gerinurse.2022.09.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To explore whether social support indirectly influences patient activation through self-efficacy in older adults living with coronary heart disease. METHODS A cross-sectional study was conducted. Older patients (n=451) from four communities in the city of Qingdao completed a questionnaire survey. We conducted multiple linear regression models and bootstrap testing to assess the relationships among social support, self-efficacy, and patient activation. RESULTS Patient activation was positively correlated with social support (r = 0.524, P < 0.01) and with self-efficacy (r = 0.740, P < 0.01). The of social support had indirect positive effect on patient activation through self-efficacy and the effect was 58.8%. CONCLUSIONS We identified the critical role of social support and self-efficacy for the activation of community-dwelling older patients living with coronary heart disease. Our findings provide essential knowledge for developing and evaluating effective interventions to promote patient activation and enhance self-management of coronary heart disease.
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15
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Batko-Szwaczka A, Francuz T, Kosowska A, Cogiel A, Dudzińska-Griszek J, Wilczyński K, Hornik B, Janusz-Jenczeń M, Włodarczyk I, Wnuk B, Szołtysek J, Durmała J, Dulawa J, Szewieczek J. Predictors of Adverse Outcomes in Healthy Aging Adults: Coronary Artery Disease, Lower Educational Status and Higher P-Selectin Levels. Clin Interv Aging 2022; 17:1173-1185. [PMID: 35957925 PMCID: PMC9362850 DOI: 10.2147/cia.s363881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Societal aging – as a global demographic phenomenon – shows no indication of abating. As a result, the problem of age-associated disability and related long-term care is emerging as a major public health challenge. It is important that methods for identifying older adults at risk of adverse outcomes are implemented early. Methods The study group consisted of 145 individuals, 44.1% women, who were randomized from community-dwelling 60–74-year-old adults. A comprehensive geriatric assessment was supplemented with Fried frailty phenotype evaluation and blood tests (including adhesion molecules, matrix metalloproteinases and neurotrophic factors). A follow-up by phone call was made for at least 3 years after the initial examination. Composite endpoint (CE) included falls, hospitalization, institutionalization and death. Results Mean study group age was 66.5 ± 4.1 years (\documentclass[12pt]{minimal}
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$$\overline {\rm{X}} {\rm{ \pm SD}}$$
\end{document}) and mean number of diseases was 3.7 ± 2.2. Functional status of the subjects was good, as indicated by high Barthel Index scores of 99.1 ± 2.4, MMSE scores of 29.0 ±1.5 and no frailty case. During a three-year follow-up, 71 participants (49.0%) experienced any CE-events. The Wilcoxon-Gehan test indicates that a higher probability of three-year CE completion was associated with an age >65 years (P = 0.006), coronary artery disease (CAD) (P = 0.008), 6-Minute Walk Test <432 m (P = 0.034), serum glucose >120 mg/dL (P = 0.047), serum cortisol >10 μg/dL (P = 0.011), leptin ≥15 ng/mL (P = 0.018), P-selectin ≥23 ng/mL (P = 0.006) and GDNF ≥20 pg/mL (P = 0.004). CAD (OR = 3.64, 95% CI = 1.53−8.69, P = 0.004), educational status (OR = 0.87, 95% CI = 0.77−0.98, P = 0.022) and P-selectin levels (OR = 1.07, 95% CI = 1.02−1.13, P = 0.013) were independent measures predicting three-year CE occurrence in multivariate logistic regression analysis adjusted for clinical and functional measures, and blood tests. Conclusion Coronary artery disease, poorer lower educational status and higher P-selectin levels were predictive of adverse outcomes in the community-dwelling healthy-aging early-old adults during three-year follow-up.
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Affiliation(s)
- Agnieszka Batko-Szwaczka
- Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
- Correspondence: Agnieszka Batko-Szwaczka, Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, Poniatowskiego 15, Katowice, 40-055, Poland, Tel +48323598239, Fax +48322059483, Email
| | - Tomasz Francuz
- Department of Biochemistry, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Agnieszka Kosowska
- Department of Biochemistry, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Anna Cogiel
- Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Joanna Dudzińska-Griszek
- Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Krzysztof Wilczyński
- Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Beata Hornik
- Department of Internal Nursing, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Magdalena Janusz-Jenczeń
- Department of Internal Nursing, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Iwona Włodarczyk
- Department of Internal Nursing, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Bartosz Wnuk
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Joanna Szołtysek
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jacek Durmała
- Department of Rehabilitation, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jan Dulawa
- Department of Internal Medicine and Metabolic Diseases, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Jan Szewieczek
- Department of Geriatrics, Faculty of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland
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Feng J, Wu Y. Interleukin-35 ameliorates cardiovascular disease by suppressing inflammatory responses and regulating immune homeostasis. Int Immunopharmacol 2022; 110:108938. [PMID: 35759811 DOI: 10.1016/j.intimp.2022.108938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/05/2022] [Accepted: 06/07/2022] [Indexed: 12/14/2022]
Abstract
The immune response is of great significance in the initiation and progression of a diversity of cardiovascular diseases involving pro-and anti-inflammatory cytokines. Interleukin-35 (IL-35), a cytokine of the interleukin-12 family, is a novel anti-inflammation and immunosuppressive cytokine, maintaining inflammatory suppression and regulating immune homeostasis. The role of IL-35 in cardiovascular diseases (CVDs) has aroused enthusiastic attention, a diversity of experimental or clinical evidence has indicated that IL-35 potentially has a pivot role in protecting against cardiovascular diseases, especially atherosclerosis and myocarditis. In this review, we initiate an overview of the relationship between Interleukin-35 and cardiovascular diseases, including atherosclerosis, acute coronary syndrome, pulmonary hypertension, abdominal aortic aneurysm, heart failure, myocardial ischemia-reperfusion, aortic dissection and myocarditis. Although the specific molecular mechanisms entailing the protective effects of IL-35 remain an unsolved issue, targeted therapies with IL-35 might provide a promising and effective solution to prevent and cure cardiovascular diseases.
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Affiliation(s)
- Jie Feng
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
| | - Yanqing Wu
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
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Antithrombotic Therapy in Elderly Patients with Acute Coronary Syndromes. J Clin Med 2022; 11:jcm11113008. [PMID: 35683397 PMCID: PMC9181473 DOI: 10.3390/jcm11113008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 04/27/2022] [Accepted: 05/10/2022] [Indexed: 02/06/2023] Open
Abstract
The treatment of acute coronary syndrome (ACS) in elderly patients continues to be a challenge because of the characteS.G.B.ristics of this population and the lack of data and specific recommendations. This review summarizes the current evidence about critical points of oral antithrombotic therapy in elderly patients. To this end, we discuss the peculiarities and differences reported referring to dual antiplatelet therapy (DAPT) in ACS management in elderly patients and what might be the best option considering these population characteristics. Furthermore, we analyze antithrombotic strategies in patients with atrial fibrillation (AF), with a particular focus on those cases that also present coronary artery disease (CAD). It is imperative to deepen our knowledge regarding the management of these challenging patients through real-world data and specifically designed geriatric studies to help resolve the questions remaining in their disease management.
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Challenges of long-term dual antiplatelet therapy use following acute coronary syndromes. Am Heart J 2022; 246:44-64. [PMID: 34933000 DOI: 10.1016/j.ahj.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/24/2021] [Accepted: 12/15/2021] [Indexed: 11/20/2022]
Abstract
An acute coronary syndrome (ACS) event is associated with a high risk of recurrent ACS, stroke, and death. To ameliorate the risk of subsequent events, current guidelines for ST-segment elevation myocardial infarction and non-ST-segment elevation ACS recommend long-term management strategies for secondary prevention including risk factor modification and anti-ischemic and antiplatelet therapies. Dual antiplatelet therapy (DAPT), comprising aspirin plus a P2Y12 inhibitor, is a critical component of secondary prevention therapy following ACS. However, despite the importance of DAPT for secondary prevention after ACS, questions remain over the optimal duration of therapy. Clinical evidence is emerging that maintenance DAPT >12 months lowers the risk of recurrent ACS events; however, this benefit must be considered against any potential risks of prolonged DAPT such as bleeding. Several tools for bleeding risk assessment have shown promise; however, their limited accuracy and discriminative power necessitates further development. Assessment of patient ischemic risk should consider the complexity of the percutaneous coronary intervention (PCI) procedure, anatomic burden of coronary artery disease, and additional underlying risk factors. Consequently, identifying patients in whom the risk:benefit ratio favors prolonged DAPT may prove invaluable for clinicians in deciding which patients should continue or stop taking DAPT at 12 months after PCI, or consider P2Y12 inhibitor monotherapy as an option. This article reviews the most recent information about the risks and benefits of DAPT continued for >12 months after ACS and provides critical guidance to assist physicians in identifying patients most likely to benefit from a secondary prevention strategy with DAPT.
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Orhan AL, Şaylık F, Çiçek V, Akbulut T, Selçuk M, Çınar T. Evaluating the systemic immune-inflammation index for in-hospital and long-term mortality in elderly non-ST-elevation myocardial infarction patients. Aging Clin Exp Res 2022; 34:1687-1695. [PMID: 35275375 DOI: 10.1007/s40520-022-02103-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/22/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION This investigation aimed to evaluate the predictive value of the systemic immune-inflammation index (SII) for in-hospital and long-term mortality in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). METHODS This retrospective investigation included 314 consecutive elderly NSTEMI patients in a tertiary center. SII is computed as (neutrophils × platelets)/lymphocytes. Based on the increased SII values, we classified the research sample into three tertile groups as T1, T2, and T3. The in-hospital and long-term mortality were defined as the primary outcomes. RESULTS Patients in the T3 group had lower chances of survival in the in-hospital and long-term periods compared with those in the T2 and T1 groups. According to the multivariable Cox regression models, SII independently related with in-hospital (hazard ratio (HR): 1.001, 95% CI: 1.000-1.1003, p = 0.038) and long-term mortality (HR: 1.004, 95% CI: 1.002-1.006, p < 0.001). To predict long-term mortality, the optimal SII value was > 2174 with 80% sensitivity and 85.4% specificity. SII had a slightly lower but statistically non-inferior discriminative ability for long-term mortality compared with the Charlson comorbidity index (CCI) in the receiver operating characteristic curve comparison (AUC: 86.2 vs. AUC: 890, p > 0.05). Additionally, combining SII with traditional risk factors and the CCI revealed a significant improvement in C-statistics. CONCLUSION This investigation may be the first to demonstrate that SII is independently linked with in-hospital and long-term mortality in elderly NSTEMI patients.
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Jiao Y, Su Y, Shen J, Hou X, Li Y, Wang J, Liu B, Qiu D, Sun Z, Chen Y, Xi Q, Shen M, Fu Z. Evaluation of the long-term prognostic ability of triglyceride-glucose index for elderly acute coronary syndrome patients: a cohort study. Cardiovasc Diabetol 2022; 21:3. [PMID: 34991602 PMCID: PMC8740408 DOI: 10.1186/s12933-021-01443-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 12/29/2021] [Indexed: 12/13/2022] Open
Abstract
Background With the advancement of the world population aging, more attention should be paid to the prognosis of elderly patients with acute coronary syndrome (ACS). Triglyceride-glucose (TyG) index is a reliable indicator of insulin resistance (IR) and is closely related to traditional risk factors of cardiovascular disease (CVD). However, the effect of TyG index on the prognosis of long-term adverse events in elderly ACS patients has not been reported. This study evaluated the prognostic power of TyG index in predicting adverse events in elderly ACS patients. Methods In this study, 662 ACS patients > 80 years old who were hospitalized from January 2006 to December 2012 were enrolled consecutively and the general clinical data and baseline blood biochemical indicators were collected. The follow-up time after discharge was 40–120 months (median, 63 months; interquartile range, 51‒74 months). In addition, the following formula was used to calculate the TyG index: Ln [fasting TG (mg/dL) × FBG (mg/dL)/2], and patients were divided into three groups according to the tertile of the TyG index. Results The mean age of the subjects was 81.87 ± 2.14 years, the proportion of females was 28.10%, and the mean TyG index was 8.76 ± 0.72. The TyG index was closely associated with the traditional risk factors of CVD. In the fully-adjusted Cox regression model, the Hazard ratio (95% CI) of all-cause mortality (in tertile 3) was 1.64 (1.06, 2.54) and major adverse cardiac event (MACE) (in tertile 3) was 1.36 (1.05, 1.95) for each SD increase in the TyG index. The subgroup analyses also confirmed the significant association of the TyG index and long-term prognosis. Conclusion The TyG index is an independent predictor of long-term all-cause mortality and MACE in elderly ACS patients.
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Affiliation(s)
- Yang Jiao
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, 100853, China
| | - Yongkang Su
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, 100853, China.,Department of Geriatrics, The Second Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Jian Shen
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, 100853, China
| | - Xiaoling Hou
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, 100853, China
| | - Ying Li
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, 100853, China
| | - Jihang Wang
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, 100853, China.,Department of Cardiology, Hainan Hospital, Chinese PLA General Hospital, Sanya, 572000, Hainan, China
| | - Bing Liu
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, 100853, China.,Department of Cardiology, 970 Hospital, Chinese PLA Joint Logistic Support Force, Weihai, 264200, Shandong, China
| | - Dongfeng Qiu
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, 100853, China
| | - Zhijun Sun
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, 100853, China
| | - Yundai Chen
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, 100853, China
| | - Qing Xi
- The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Mingzhi Shen
- Department of Cardiology, Hainan Hospital, Chinese PLA General Hospital, Sanya, 572000, Hainan, China.
| | - Zhenhong Fu
- Senior Department of Cardiology, The Sixth Medical Center, Chinese PLA General Hospital and Chinese PLA Medical School, Beijing, 100853, China.
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