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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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A. Basics
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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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28. Risk Factors and Prevention
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31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Coronary angioplasty for octogenarian acute coronary syndrome patients? Is it worth it?
Session:
Posters 4 - Écran 3 - Doença Coronária
Speaker:
Carolina Saleiro
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Carolina Saleiro; Diana Decampos; Rogerio Teixeira; João Lopes; José Pedro Sousa; Joana M. Ribeiro; Luís Puga; Carolina Lourenço; Marco Costa; Lino Gonçalves
Abstract
<p><strong>Background: </strong>As the population ages, doctors are being challenged by the decision to offer intervention treatment in increasingly older and fragile patients. The comorbidity burden and performance status should be considered when making the decision.</p> <p><strong>Aim: </strong>To assess the impact of optimal medical therapy (OMT) versus percutaneous coronary intervention (PCI) in non-ST elevation acute coronary syndrome (ACS) patients older than 80 years.</p> <p><strong>Methods: </strong>182 patients older than 80 years old admitted to a single coronary care unit with a diagnosis of non-ST elevation ACS, who survived hospital stay were included. Clinical, laboratorial and echocardiographic data were evaluated. Two groups were created: Group A (OMT group) N=83; Group B (PCI group) N=99. The primary endpoint was long-term all-cause mortality. Kaplan-Meyer curves and Cox regression were conducted to evaluate the impact of OMT versus PCI on the primary endpoint. The mean time of follow-up was 37±29 months.</p> <p><strong>Results</strong>: Groups were homogenous regarding gender, cardiovascular risk factors, heart failure diagnosis, left ventricular (LV) systolic function and peak troponin I. OMT group patients were older (85.1±3.7 vs 82.7±3.2 years old, <em>P<0.01), </em>had a higher prevalence of chronic kidney disease (CKD) (61.4% vs 46.5%, <em>P<0.05)</em>, a lower haemoglobin (Hb) level (12.0±1.9 vs 12.6±1.7 g/dL, <em>P<0.05)</em> and were less likely to receive double antiplatelet therapy at discharge (80.8% vs 100%, <em>P<0.001)</em>. 84 patients met the primary outcome. Kaplan-Meyer curves showed increased survival in the PCI group (36.5% vs 59.3%, Log Rank <em>P<0.001 – Figure 1</em>). Nevertheless, PCI was not associated with long-term mortality (HR 1.05, 95% CI 0.98-1.12) in a model adjusted for age, CKD, peak troponin, LV systolic function and Hb level. Only Hb (HR 0.81, 95% CI 0.73-0.93), peak troponin (HR 1.01, 95% CI 1.00-1.01) and LV function (slightly impaired [HR 1.89, 95% CI 1.03-3,48] and moderate/severely impaired [HR 1.96, 95% CI 1.14-3.36]) remained associated with the outcome.</p> <p><strong>Conclusion: </strong>Increased survival in older patients receiving PCI after a non-ST elevation ACS may be ascribed to the selection of patients with less comorbidities. This reinforces the idea it may be applied in well-fit patients regardless of age. In our elderly population, lower Hb level, peak troponin and impaired LV systolic function appear to be the main contributors to decreased survival, irrespective of intervention.</p>
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