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Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term mortality.

https://arctichealth.org/en/permalink/ahliterature273526
Source
Clin Interv Aging. 2015;10:1547-53
Publication Type
Article
Date
2015
Author
Salim Bary Barywani
Shijun Li
Maria Lindh
Josefin Ekelund
Max Petzold
Per Albertsson
Lars H Lund
Michael Lx Fu
Source
Clin Interv Aging. 2015;10:1547-53
Date
2015
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - mortality - therapy
Aged, 80 and over
Cause of Death
Female
Humans
Kaplan-Meier Estimate
Male
Percutaneous Coronary Intervention
Propensity Score
Risk factors
Sweden - epidemiology
Abstract
Evidence of improved survival after use of percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS) is limited. We assessed the association between PCI and long-term mortality in octogenarians with ACS.
We followed 353 consecutive patients aged =80 years hospitalized with ACS during 2006-2007. Among them, 182 were treated with PCI, whereas 171 were not. PCI-treated patients were younger and more often male, and had less stroke and dependency in activities of daily living, but there were no significant differences in occurrence of diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and uncured malignancies between the two groups. The association between PCI and all-cause mortality was assessed in the overall cohort and a 1:1 matched cohort based on propensity score (PS). In overall cohort, 5-year all-cause mortality was 46.2% and 89.5% in the PCI and non-PCI groups, respectively. Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P
Notes
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PubMed ID
26451095 View in PubMed
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Acute coronary syndromes: a Canadian perspective.

https://arctichealth.org/en/permalink/ahliterature129039
Source
Can J Cardiol. 2011 Nov-Dec;27 Suppl A:S385-6
Publication Type
Article
Author
David H Fitchett
Author Affiliation
St Michael's Hospital, University of Toronto and Canadian Heart Research Centre, Toronto, Ontario, Canada. fitchettd@smh.ca
Source
Can J Cardiol. 2011 Nov-Dec;27 Suppl A:S385-6
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - mortality - therapy
Canada - epidemiology
Fibrinolytic Agents - therapeutic use
Humans
Platelet Aggregation Inhibitors - therapeutic use
Practice Guidelines as Topic
PubMed ID
22118041 View in PubMed
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Frailty and outcome in elderly patients with acute coronary syndrome.

https://arctichealth.org/en/permalink/ahliterature106369
Source
Can J Cardiol. 2013 Dec;29(12):1610-5
Publication Type
Article
Date
Dec-2013
Author
Michelle M Graham
P Diane Galbraith
Deirdre O'Neill
Darryl B Rolfson
Candace Dando
Colleen M Norris
Author Affiliation
Department of Medicine and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; The Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada. Electronic address: mmg2@ualberta.ca.
Source
Can J Cardiol. 2013 Dec;29(12):1610-5
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - mortality - therapy
Aged
Aged, 80 and over
Alberta
Cohort Studies
Comorbidity
Female
Follow-Up Studies
Frail Elderly - statistics & numerical data
Geriatric Assessment - statistics & numerical data
Humans
Length of Stay
Linear Models
Male
Patient Outcome Assessment
Pilot Projects
Abstract
Frailty is superior to chronological age as a predictor of outcome. The Edmonton Frail Scale (EFS) is a simple valid measure of frailty, covering multiple important domains, with scores ranging from 0 (not frail) to 17 (very frail). The purpose of this pilot study was to assess the EFS in a group of elderly patients with acute coronary syndrome (ACS).
The EFS was administered to 183 consecutive patients with ACS aged = 65 years admitted to a single centre in Edmonton, Alberta, Canada.
Scores ranged from 0-13. Patients with higher EFS scores were older, with more comorbidities, longer lengths of stay (EFS 0-3: mean, 7.0 days; EFS 4-6: mean, 9.7 days; and EFS = 7: mean, 12.7 days; P = 0.03), and decreased procedure use. Crude mortality rates at 1 year were 1.6% for EFS 0-3, 7.7% for EFS 4-6, and 12.7% for EFS = 7 (P = 0.05). After adjusting for baseline risk differences using a "burden of illness" score, the hazard ratio for mortality for EFS = 7 compared with EFS 0-3 was 3.49 (95% confidence interval [CI], 1.08-7.61; P = 0.002).
The EFS is associated with increased comorbidity, longer lengths of stay, and decreased procedure use. After adjustment for burden of illness, the highest frailty category is independently associated with mortality in elderly patients with ACS. Further work is needed to determine whether the use of a validated frailty instrument would better delineate medical decision making in this important, often disadvantaged population.
PubMed ID
24183299 View in PubMed
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How has the management of acute coronary syndrome changed in the Russian Federation during the last 10 years?

https://arctichealth.org/en/permalink/ahliterature292598
Source
Health Policy. 2017 Dec; 121(12):1274-1279
Publication Type
Journal Article
Date
Dec-2017
Author
Anna Kontsevaya
Tamara Sabgaida
Alla Ivanova
David A Leon
Martin McKee
Author Affiliation
Department of Non-communicable Disease Epidemiology, National Research Center for Preventive Medicine, Moscow, Russian Federation. Electronic address: AKontsevaya@gnicpm.ru.
Source
Health Policy. 2017 Dec; 121(12):1274-1279
Date
Dec-2017
Language
English
Publication Type
Journal Article
Keywords
Acute Coronary Syndrome - mortality - therapy
Economics
Hospital Mortality - trends
Humans
Myocardial Infarction - therapy
Myocardial Revascularization
Percutaneous Coronary Intervention - trends
Russia - epidemiology
Stents - utilization
Thrombolytic Therapy - trends
Abstract
We report trends and patterns of percutaneous cardiovascular interventions (PCI) by region for 2005-2009, with more detailed data on management of myocardial infarctions in 2009-2103, relating them to regional economic development and changes in mortality from myocardial infarction.
PCIs per 100,000 population increased from 8.7 in 2005-71.3 in 2013, with considerable regional variation. In 2013 the highest rates were in the wealthiest regions, although not in some remote regions dependent on oil and mineral extraction. Between 2009 and 2013 rates of thrombolysis in those with acute myocardial infarctions potentially eligible for treatment remained broadly similar at about 28% but rates of primary revascularisation with stenting rose rapidly, from 6.5% to 23.7%. In-hospital mortality from myocardial infarction since 2009 has declined most in regions achieving highest rates of primary revascularisation.
The sustained investment in advanced cardiovascular technology has been associated with substantial increases in revascularisation in some but not all regions. However, rates overall remain far behind those in Western Europe. Further research is in progress to understand the reasons for these variations and the barriers to further expansion of services.
Notes
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PubMed ID
29029811 View in PubMed
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Outcome of patients with acute coronary syndromes enrolled in clinical trials.

https://arctichealth.org/en/permalink/ahliterature149618
Source
Coron Artery Dis. 2009 Nov;20(7):473-6
Publication Type
Article
Date
Nov-2009
Author
Amit Segev
Paul Fefer
Bradley H Strauss
Shlomi Matetzky
Mary Tan
Anatoly Langer
Shaun G Goodman
Author Affiliation
Terrence Donnelly Heart Centre, Division of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Canada. amit.segev@sheba.health.gov.il
Source
Coron Artery Dis. 2009 Nov;20(7):473-6
Date
Nov-2009
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - mortality - therapy
Aged
Angioplasty, Balloon, Coronary - adverse effects - mortality - utilization
Canada - epidemiology
Cardiovascular Agents - therapeutic use
Clinical Trials as Topic
Coronary Artery Bypass - adverse effects - mortality - utilization
Evidence-Based Medicine
Female
Health Services Accessibility
Hospital Mortality
Humans
Inpatients
Logistic Models
Male
Middle Aged
Odds Ratio
Outcome and Process Assessment (Health Care)
Registries
Risk assessment
Risk factors
Time Factors
Treatment Outcome
Abstract
The objective of this study was to evaluate in-hospital and 1-year outcomes of patients with acute coronary syndrome (ACS) enrolled in clinical studies. Among patients included in the Canadian ACS Registries, patients enrolled in clinical studies (n = 883, 13.4%) were compared with patients who were not enrolled. Enrolled patients were younger, more likely to be smokers, had less diabetes, less hypertension, less previous myocardial infarction, and less previous percutaneous coronary intervention and coronary artery bypass grafting. Enrollment in clinical studies was higher in patients with ST-elevation and ST-depression ACS. Furthermore, patients enrolled had more coronary interventions (percutaneous coronary intervention and coronary artery bypass grafting) and received more evidence-based therapies such as aspirin and statins. Unadjusted event rates were significantly higher in patients not enrolled in clinical studies: in-hospital death 2.4 versus 1.1% (P = 0.02), and 1-year death 9.2 versus 6.1% (P = 0.003), and death or myocardial infarction 16.1 versus 13.8% (P = 0.09). After multivariable analysis, enrollment in clinical studies showed a trend towards decreased in-hospital and 1-year death. Patients with ACS in Canada who participate in clinical studies are more likely to receive evidence-based therapies and interventions throughout hospitalization. After multivariable analysis, enrollment in a clinical trial may also contribute to better in-hospital and 1-year outcome.
PubMed ID
19609208 View in PubMed
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[Results of percutaneous coronary angioplasty and effect on the patients' condition and symptoms].

https://arctichealth.org/en/permalink/ahliterature104961
Source
Duodecim. 2014;130(1):63-70
Publication Type
Article
Date
2014
Author
Heidi Kemiläinen
Johanna Kaulamo
Outi Heikkinen
Heikki Miettinen
Johanna Kuusisto
Author Affiliation
Sisätauteihin erikoistuva Iääkäri, Itä-Suomen yliopisto.
Source
Duodecim. 2014;130(1):63-70
Date
2014
Language
Finnish
Publication Type
Article
Keywords
Acute Coronary Syndrome - mortality - therapy
Angioplasty, Balloon, Coronary
Endpoint Determination
Female
Finland - epidemiology
Follow-Up Studies
Humans
Male
Stents
Treatment Outcome
Abstract
More than 10,000 percutaneous coronary angioplasties are performed in Finland annually. We examined in a three-year follow-up the results of percutaneous coronary angioplasty performed for 875 patients at the Kuopio University Hospital. Procedural and end-point data were collected from patient records and by mail inquiry. Out of three balloon angioplasties, two were performed for patients having an acute coronary syndrome. One bioactive or drug-eluting stent was inserted for two thirds of the patients. Procedural complications and mortality over three years among patients treated with balloon angioplasty were of good international standard, and balloon angioplasty improved the patients' condition.
PubMed ID
24547626 View in PubMed
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Similar outcome with an invasive strategy in men and women with non-ST-elevation acute coronary syndromes: from the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART).

https://arctichealth.org/en/permalink/ahliterature131393
Source
Eur Heart J. 2011 Dec;32(24):3128-36
Publication Type
Article
Date
Dec-2011
Author
Joakim Alfredsson
Johan Lindbäck
Lars Wallentin
Eva Swahn
Author Affiliation
Division of Cardiovascular Medicine, Department of Medicine and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden. joakim.alfredsson@liu.se
Source
Eur Heart J. 2011 Dec;32(24):3128-36
Date
Dec-2011
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - mortality - therapy
Aged
Coronary Artery Disease - mortality
Female
Humans
Male
Middle Aged
Myocardial Infarction - etiology - mortality
Myocardial Revascularization - methods - mortality
Propensity Score
Registries
Risk assessment
Sex Distribution
Sweden - epidemiology
Treatment Outcome
Abstract
To assess gender differences in outcome with an early invasive or non-invasive strategy in patients with non-ST-elevation acute coronary syndromes (NSTE ACS).
We included 46,455 patients [14 819 women (32%) and 31,636 men (68%)] from the SWEDEHEART register, with NSTE ACS, between 2000 and 2006, and followed them for 1 year. In the non-invasive strategy arm, the relative risk (RR) of death was (women vs. men) 1.02 [95% confidence interval (CI), 0.94-1.11] and in the invasive strategy arm 1.12 (95% CI, 0.96-1.29). After adjustment for baseline differences between the genders, with propensity score and discharge medication, there was a similar trend towards better outcome among women in both the early non-invasive cohort [RR 0.90 (95% CI, 0.82-0.99)] and the early invasive cohort [RR 0.90 (95% CI, 0.76-1.06)], although it did not reach statistical significance in the early invasive cohort. Results were similar with the combined endpoint death/myocardial infarction. An early invasive treatment was associated with a marked, and similar, mortality reduction in women [RR 0.46 (95% CI, 0.38-0.55)] and men [RR 0.45 (95% CI, 0.40-0.52)], without interaction with gender.
In this large cohort of patients with NSTE ACS, reflecting real-life management, women and men had similar and better outcome associated with an invasive strategy.
Notes
Comment In: Eur Heart J. 2011 Dec;32(24):3070-222003153
PubMed ID
21911338 View in PubMed
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Time dependency of outcomes for drug-eluting vs bare-metal stents.

https://arctichealth.org/en/permalink/ahliterature106001
Source
Can J Cardiol. 2013 Dec;29(12):1616-22
Publication Type
Article
Date
Dec-2013
Author
Alexander A Leung
Danielle A Southern
P Diane Galbraith
Merril L Knudtson
Andrew C Philpott
William A Ghali
Author Affiliation
Department of Medicine, University of Calgary, Alberta, Canada.
Source
Can J Cardiol. 2013 Dec;29(12):1616-22
Date
Dec-2013
Language
English
Publication Type
Article
Keywords
Acute Coronary Syndrome - mortality - therapy
Aged
Alberta
Angioplasty, Balloon, Coronary - statistics & numerical data
Cohort Studies
Coronary Stenosis - mortality - therapy
Drug-Eluting Stents - statistics & numerical data
Equipment Failure
Female
Humans
Kaplan-Meier Estimate
Male
Metals
Middle Aged
Paclitaxel - administration & dosage
Patient Outcome Assessment
Propensity Score
Proportional Hazards Models
Prospective Studies
Registries
Risk
Sirolimus - administration & dosage
Stents
Survival Rate
Time Factors
Abstract
Previous research suggests that the early benefit from revascularization with drug-eluting stents might diminish over time.
We performed an extended analysis of a previously identified cohort of 6440 patients who underwent percutaneous coronary intervention between April 1, 2003 and March 31, 2005 using a prospective provincial clinical registry in Alberta, Canada. We compared rates of death, and of death or repeat revascularization among the 6440 patients receiving either drug-eluting (sirolimus- and paclitaxel) stents or bare-metal stents. We determined risk-adjusted hazard ratios at moments in time with a spline analysis using Cox proportional hazards modelling.
During the 8 years of observation, the relative risks for death or the composite outcome of death or repeat revascularization varied over time. There was an early finding of better outcomes associated with drug-eluting stents in the first year after implantation. Thereafter, there was no significant benefit associated with drug-eluting stents compared with bare-metal stents with 8 years of follow-up. At 30 days, the adjusted hazard ratio was 0.38 (95% confidence interval [CI], 0.18-0.81) for death and 0.27 (95% CI, 0.14-0.54) for the composite outcome of death or repeat revascularization. By 8 years, the adjusted hazard ratio of death or the composite outcome was 1.15 (95% CI, 0.97-1.36) and 1.01 (95% CI, 0.87-1.17), respectively.
Revascularization with first-generation drug-eluting stents is associated with better outcomes within the first year only. Thereafter, the risk of death or repeat revascularization is similar between drug-eluting stents and bare-metal stents.
PubMed ID
24267804 View in PubMed
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8 records – page 1 of 1.