Benefits of coronary revascularization in septuagenarian patients with acute coronary syndrome

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Published Sep 25, 2013
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Vol. 91 No. 9 (2013): Issue Sep 2013

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Habib Ben Ahmed
Imen Hamdi
Taoufik Elkateb
Fadoua Ben Hassan
Aida Mokaddem
Youssef Ben Ameur
Mohamed Rachid Boujnah

Abstract

Background: Prognosis of acute coronary syndrome (ACS) in elderly patients is bleak. Also older people tend to receive less invasive treatment than younger patients.
aim: To analyze the impact of coronary revascularization on the mid-term outcome of septuagenarian patients admitted with ACS.
methods: We retrospectively studied 250 patients 70 years or older hospitalised for ACS between january 2006 to september2010.
results: This population was more likely to be male with mean age 74 years and 93 % of ACS were inaugural events (60% NSTEMI, 40% STEMI). Coronary angiograms showed complex coronary lesions with a high incidence of multivessel disease, bifurcation lesions, and calcified stenosis. Seventy-six patients were treated medically and 174 underwent percutaneous or surgical revascularization. At six-month clinical follow-up, major adverse cardiac events (MACE) were significantly higher in medically treated than revascularized patients (62% Vs 31.7%, P <0.001). Patients with invasive strategy have significantly higher event free survival rate comparing to those assigned to medical management (64% Vs 49.7%, p: 0.01).
Conclusion: Our study confirmed the superiority of invasive strategy compared to medical treatment in septuagenarian patients with acute coronary syndromes. Advanced age should not exclude patients from invasive strategy with complete revascularization

Keywords:

Acute coronary syndrome, elderly, coronary revascularization.

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References

  1. Alexander KP, Newby LK, Armstrong PW, et al. Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation 2007; 115:2570-89.
  2. Dynina O, Vakili BA, Slater JN, et al. In-hospital outcomes of contemporary percutaneous coronary interventions in the very elderly. Catheter Cardiovasc Interv 2003; 58:351-57.
  3. Chauhan MS, Kuntz RE, Ho KL, et al. Coronary artery stenting in the aged. J. Am. Coll. Cardiol 2001; 37:856-62.
  4. Klein LW, Block P, Brindis RG, et al. Percutaneous coronary interventions in octogenarians in the American College of Cardiology-National Cardiovascular Data Registry: development of a nomogram predictive of in-hospital mortality. J. Am. Coll. Cardiol 2002; 40:394-402.
  5. Kaiser C, Kuster GM, Erne P, et al. Risks and benefits of optimised medical and revascularization therapy in elderly patients with angina--on-treatment analysis of the TIME trial. Eur. Heart J 2004; 25:1036-42.
  6. Boden WE, O'Rourke RA, Teo KK, et al. Impact of optimal medical therapy with or without percutaneous coronary intervention on long-term cardiovascular end points in patients with stable coronary artery disease (from the COURAGE Trial). Am. J. Cardiol 2009; 104:1-4.
  7. Graham MM, Ghali WA, Faris PD, et al. Survival after coronary revascularization in the elderly. Circulation 2002; 105:2378-84.
  8. Hanon O, Baixas C, Friocourt P, et al. Consensus of the French Society of Gerontology and Geriatrics and the French Society of Cardiology for the management of coronary artery disease in older adults. Arch Cardiovasc Dis 2009; 102:829-45.
  9. Avezum A, Makdisse M, Spencer F, et al. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am. Heart J 2005; 149:67-73.
  10. Hirose H, Amano A, Yoshida S, et al. Coronary artery bypass grafting in the elderly. Chest 2000; 117:1262-70.
  11. Zaidi AM, Fitzpatrick AP, Keenan DJ, et al. Good outcomes from cardiac surgery in the over 70s. Heart 1999; 82:134-37.
  12. Freeman WK, Schaff HV, O'Brien PC, et al. Cardiac surgery in the octogenarian: perioperative outcome and clinical follow-up. J Am Coll Cardiol 1991; 18:29-35.
  13. Ko W, Gold JP, Lazzaro R, et al. Survival analysis of octogenarian patients with coronary artery disease managed by elective coronary artery bypass surgery versus conventional medical treatment. Circulation 1992; 86:II191-97.
  14. Mullany CJ, Darling GE, Pluth JR, et al. Early and late results after isolated coronary artery bypass surgery in 159 patients aged 80 years and older. Circulation 1990; 82:IV229-236.
  15. Gogbashian A, Sedrakyan A, Treasure T. EuroSCORE: a systematic review of international performance. Eur J Cardiothorac Surg 2004; 25:695-700.
  16. Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month post discharge death in an international registry. JAMA 2004; 291:2727-33.
  17. Elbaz M, Fourcade J, Carrie D, et al. Coronary artery disease in octogenarians: contribution of coronary angiography and evaluation of therapeutic possibilities. Arch Mal Coeur Vaiss 1995; 88:1391-98.
  18. Christiaens L, Mankoubi L, Coisne D, et al. Coronary angiography in octogenarians. Therapeutic impact and medium-term follow-up. Arch Mal Coeur Vaiss 1998; 91:1125-31.
  19. Bagnall AJ, Goodman SG, Fox KAA, et al. Influence of age on use of cardiac catheterization and associated outcomes in patients with non-ST-elevation acute coronary syndromes. Am J Cardiol 2009; 103:1530-36.
  20. Rathore SS, Mehta RH, Wang Y, et al. Effects of age on the quality of care provided to older patients with acute myocardial infarction. Am J Med 2003; 114:307-15
  21. Hasdai D, Behar S, Wallentin L, et al. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). Eur Heart J 2002; 23:1190-1201.
  22. Cohen MG, Filby SJ ,Roe MT, et al .The paradoxical use of cardiac catheterization in patients with non-ST-elevation acute coronary syndromes: lessons from the Can Rapid Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC /AHA Guidelines (CRUSADE) Quality Improvement Initiative .Am Heart J. 2009;158:263-70.
  23. Bach RG, Cannon CP, Weintraub WS, et al. The effect of routine, early invasive management on outcome for elderly patients with non- ST-segment elevation acute coronary syndromes. Ann Intern Med 2004; 141:186-95.