Coronary artery disease in the elderly

1999 ◽  
Vol 9 (1) ◽  
pp. 13-21 ◽  
Author(s):  
SK Glen ◽  
NA Boon
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Treatment Guidelines ◽  
Treatment Options ◽  
The Elderly ◽  
Elderly Subjects ◽  
Younger Patients ◽  
Artery Disease ◽  
Morbid Conditions

Coronary artery disease is extremely common among elderly people and accounts for half of all deaths in those who are more than 65 years old. Although the condition is essentially the same as that encountered in younger patients, the management of coronary artery disease in elderly subjects can be difficult because the anticipated benefits and risks of the various treatment options are often altered by the presence of co-morbid conditions. Moreover, the results of the major outcome studies that underpin most treatment guidelines may not be relevant to the needs of many elderly patients for several reasons.

Features of diabetes mellitus in very elderly patients

2019 ◽  
Vol 1 (9) ◽  
pp. 13-19
Author(s):  
S. V. Topolyanskaya ◽  
T. M. Kolontai ◽  
O. N. Vaculenko ◽  
L. I. Dvoretski
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Very Elderly ◽  
Younger Patients ◽  
Patients With Diabetes ◽  
Artery Disease

Modern concepts about features of diabetes mellitus in very elderly patients are described in the article. Special attention to the therapeutic methods of management of very elderly patients with diabetes mellitus has been devoted. The results of diabetes mellitus study in patients with coronary artery disease older than 75 years in comparison with younger patients are presented.

scholarly journals Noninvasive Testing for Diagnosis of Stable Coronary Artery Disease in the Elderly

2020 ◽  
Vol 21 (17) ◽  
pp. 6263
Author(s):  
Sergey G. Kozlov ◽  
Olga V. Chernova ◽  
Elena V. Gerasimova ◽  
Ekaterina A. Ivanova ◽  
Alexander N. Orekhov
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Elderly Population ◽  
The Elderly ◽  
The United States ◽  
Diagnostic Methods ◽  
Exercise Stress ◽  
Attractive Alternative ◽  
Artery Disease

Efficient diagnostic approaches to detect coronary artery disease (CAD) in elderly patients are necessary to ensure optimal and timely treatment. The population of suspected CAD patients older than 70 years is especially vulnerable and constantly growing. Finding the optimal diagnostic approach is challenging due to certain features of this population, such as high prevalence of comorbidities, existing contraindications to exercise tests or cognitive decline, which hinders correct assessment of the patient’s situation. Moreover, some symptoms of CAD can have variable significance in the elderly compared to younger adult groups. In this review, we present current recommendations of the United States (US) and European cardiologists’ associations and discuss their applicability for diagnostics in the elderly population. Exercise electrocardiogram (ECG) and exercise stress echocardiography (SE) tests are not feasible for a substantial proportion of elderly patients. Coronary computed tomography angiography (CTA) appears to be an attractive alternative for such patients, but is not universally applicable; for instance, it is problematic in patients with significant calcification of the vessels. Moreover, more studies are needed to compare the results delivered by CTA to those of other diagnostic methods. Future efforts should be focused on comparative studies to better understand the limits and advantages of different diagnostic methods and their combinations. It is possible that some of the currently used diagnostic criteria could be improved to better accommodate the needs of the elderly population.

scholarly journals Ten-year all-cause death in elderly patients undergoing percutaneous coronary intervention or coronary artery bypass grafting: a prespecified subgroup analysis of the SYNTAX Extended Survival study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Ono ◽  
K Takahashi ◽  
H Hara ◽  
C Gao ◽  
R Wang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
De Novo ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
The Elderly ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Extended Survival

Abstract Background Coronary artery disease is the leading cause of death among elderly men and women worldwide. The aging society worldwide will lead to increasing numbers of elderly patients with multivessel coronary artery disease. Although age is recognized as one of the most important factors in a decision-making for revascularization of multivessel coronary artery disease, the very long-term outcomes in patients undergoing revascularization by percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is still unclear. Objectives The aim of the present study was to investigate the association between revascularization strategies and 10-year outcomes in elderly patients. Methods The SYNTAX Extended Survival (SYNTAXES) study (NCT 03417050) is an investigator-driven extension of follow-up of a multicentre, randomised controlled trial done in 85 hospitals across 18 North American and European countries, enrolling 1,800 patients with de novo three-vessel disease (3VD) and/or left main coronary artery disease (LMCAD) randomized to revascularization strategy with CABG versus PCI in the SYNTAX trial. Patients were divided into two groups according to the prespecified threshold of 70 years old; elderly patients (>70 years) and non-elderly patients (≤70 years). The primary endpoint of this study was all-cause death at 10 years. Results Out of 1,800 patients, 575 patients (31.9%) were classified as elderly (>70 years). The mean age ± standard deviation (SD) of the elderly patients and the non-elderly patients was 75.8±3.6 years and 60.1±7.4 years, respectively. Of note, elderly patients were more frequently female than non-elderly patients (33.6% vs. 17.1%, p<0.001). As expected, the elderly patients had higher prevalence of chronic kidney disease (43.4% vs. 7.9%, p<0.001), had higher anatomical SYNTAX score (30.2±11.8 vs 28.0±11.2 p<0.001) when compared to those of the non-elderly patients. Up to 10 years, all-cause death occurred in 42.7% and 18.9% in the elderly and non-elderly patients, respectively (Log-rank p<0.001). The cubic spline curve showed an exponentially increase in all-cause death at 10 years according to the increase of age both in the PCI arm and the CABG arm. At 10 years, there was no significant difference in the risk of all-cause death between CABG vs. PCI either in elderly patients (41.5% vs. 44.0%; Log-rank p=0.53) or non-elderly patients (16.6% vs. 21.1%; Log-rank p=0.051). Conclusion CABG and PCI were equipoise in terms of risk of all-cause death at 10 years in patients with de novo 3VD and/or LMCAD irrespective of their age when stratified according to the prespecified threshold of 70 years old. Kaplan-Meier curves Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): German Foundation of Heart Research

scholarly journals Nonivasive detection and prognosis of coronary artery disease in the elderly patients. Usefulness of dipyridamoleloading myocardial scintigraphy.

1987 ◽  
Vol 76 (8) ◽  
pp. 1230-1237
Author(s):  
Naohisa HAMASHIGE ◽  
Yoshinori DOI ◽  
Yoshihiro YONEZAWA ◽  
Hiroaki ODAWARA ◽  
Akiko KAWAMOTO ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
The Elderly ◽  
Myocardial Scintigraphy ◽  
Artery Disease

scholarly journals Assessment of the CHA2DS2-VASc Score for the Prediction of Death in Elderly Patients With Coronary Artery Disease and Atrial Fibrillation

2021 ◽  
Vol 8 ◽  
Author(s):  
Yangxun Wu ◽  
Guanyun Wang ◽  
Lisha Dong ◽  
Liu'an Qin ◽  
Jian Li ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
The Elderly ◽  
Predictive Values ◽  
Risk Of Death ◽  
Risk Of Mortality ◽  
Artery Disease

Purpose: Coronary artery disease (CAD) and atrial fibrillation (AF) often coexist and lead to a much higher risk of mortality in the elderly population. The aim of this study was to investigate whether the CHA2DS2-VASc score could predict the risk of death in elderly patients with CAD and AF.Methods: Hospitalized patients aged ≥65 years with a diagnosis of CAD and AF were recruited consecutively. Patients were divided into 5 groups according to the CHA2DS2-VASc score (≤2, =3, =4, =5, and ≥6). At least a 1-year follow-up was carried out for the assessment of all-cause death.Results: A total of 1,579 eligible patients were recruited, with 582 all-cause deaths (6.86 per 100 patient-years) occurring during a follow-up of at least 1 year. With the increase in the CHA2DS2-VASc score, the 1-year and 5-year survival rate decreased (96.4% vs. 95.7% vs. 94.0% vs. 86.5% vs. 85.7%, respectively, P < 0.001; 78.4% vs. 68.9% vs. 64.6% vs. 55.5% vs. 50.0%, respectively, P < 0.001). Compared with the patients with CHA2DS2-VASc score <5, for patients with CHA2DS2-VASc score ≥5, the adjusted hazard ratio for death was 1.78 (95% CI: 1.45–2.18, P < 0.001). The predictive values of the CHA2DS2-VASc score ≥5 for in-hospital (C-index = 0.66, 95% CI: 0.62–0.69, P < 0.001), 1-year (C-index = 0.65, 95% CI: 0.63–0.67, P < 0.001) and 5-year (C-index = 0.60, 95% CI: 0.59–0.61, P < 0.001) death were in comparable.Conclusion: In elderly patients with concomitant CAD and AF, the CHA2DS2-VASc score can be used to predict death with moderate accuracy.

MO719PERITONEAL DIALYSIS IN ELDERLY PATIENTS

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Sonia Achouch ◽  
Samia Barbouch ◽  
Meriam Hajji ◽  
Nadia Cherni ◽  
Mondher Ounissi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
The Elderly ◽  
Care And Support ◽  
Adequate Care ◽  
The Mean ◽  
Artery Disease ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Peritoneal Dialysis (PD) is now often being initiated in older patients. The benefits of this modality of dialysis have been well demonstrated in the literature. The aim of our study was to analyse the epidemiological and clinical profile of the elderly patients and to determine predictive factors of mortality Method It was a retrospective study including 51 case defined as patients ≥65-year-old, treated by PD in the Internal Medicine Department of the Charles Nicolle hospital during the period between 1986 and 2020. Results Fifty one patients were enrolled in the study. Their mean age was 71,6 ± 5,4 years [65 - 86]. There were 32 men (62, 7%) and 19 women (37,2%) . The method of initiation was the PD in 53, 84%. Diabetic and vascular nephropathy was the first cause of End-Stage Renal Disease in 56% and 19,6%. The mean Charlson score was 5,5 ± 1,4 [3-9]. The mean age when using PD was 70.8 ± 6 years [54-86]. Autonomous and active patients were detected in 29.4%. Diabetes mellitus, hypertension and coronary artery disease was observed in 58,8%, 29,4% and 15.7% of patients. In our study, 82.35% started on automated PD (APD) and 17,6% on continuous ambulatory PD (CAPD). The rate of mortality was 53%. Switching modality from PD to hemodialysis occurred in 29,4% of cases. A univariate logistic regression identified a coronary artery disease as significantly associated with increased mortality (HR=2,1 [1-2,1, IC 95%](p=0.035)). Conclusion Elderly patients on dialysis face many issues but can have continued success with PD when they have adequate care and support. The control of the morbidities such as coronary artery disease is important to decrease the rate of mortality in patients using this modality of dialysis.

P956Management of coronary artery disease in elderly patients with ischemic heart failure and reduced ejection fraction - insights from the COMMIT-HF study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Pyka ◽  
M Hawranek ◽  
M Tajstra ◽  
L Siedlecki ◽  
J Gorol ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Ejection Fraction ◽  
Elderly Patients ◽  
The Elderly ◽  
Clinical Profile ◽  
Artery Disease

Abstract Background Heart failure (HF) is one of the most important global health problems in developed and ageing societies. Coronary artery disease (CAD) is the most common etiologic factor, related to poor outcomes. Data on CAD management in HF is scarce, especially when addressing subpopulations often omitted in randomized trials, such as the elderly. Purpose With a large cohort of HF patients (n=2730) we have decided to assess the clinical profile, treatment modalities and outcomes in elderly patients undergoing percutaneous coronary intervention (PCI). Methods We analyzed a large single-center all-comer registry of HF patients (left ventricular ejection fraction LVEF≤35%) treated in a large-volume cardiovascular center (2009–2015). Acute coronary syndromes on admission were excluded. Patients with ischemic etiology were selected for further analysis (n=1703) and subsequently divided into the elderly (≥75 y.o., n=346) and young (<75 y.o., n=1357) subgroups. Results The elderly group had understandably a worse clinical profile (mean age 79,1±3,5 vs 61,2±8,2, p<0,001; male 75,2 vs 85,4%, p<0,001; NYHA III & IV 60,3 vs 49,6%, p=0,07; diabetes 50,3 vs 44,9%, p=0,07; AF 35,8 vs 22,0%; p≤0,001; anemia 52,6 vs 36,7%, p<0,001; chronic kidney disease stage III-V 54,1 vs 28,9%, p<0,001; severe mitral insufficiency 13,3 vs 8,7%, p=0,01; history of myocardial infarction 68,8 vs 67,4%, p=0,62).ICD or CRT-D were implanted less frequently in the elderly (56,1 vs 68,5%; p<0,001). Echo analysis revealed significantly better LVEF (27,95,3± vs 25,9±6,0%, p<0,001) and less ventricular dilation (LVEDV 159±61 vs 205±82 ml, p<0,001). Coronary angiography was performed frequently in both groups (78,6 vs 74,9%, p=0,15). Significant lesions were observed in 73,5 and 65,0% of cases respectively (p=0,008). The elderly were insignificantly less frequently qualified for CABG (9,0 vs 12,5%, p=0,17). Proportion of patients qualified for medical management of CAD was similar (23,5 vs 20,7%, p=0,40). PCI was performed frequently in both groups (59,5 vs 57,9%, p=0,69), often as multi-vessel procedures (34,4 vs 32,4%, p=0,67). There was a trend towards more complete revascularization in the younger patients (50,0 vs 59,5%, p=0,06). 12-month all-cause mortality was significantly higher in the elderly (20,3 vs 7,8%, p<0,001). Periprocedural compilications were very low and comparable (bleeding and/or need for transfusion, stroke and myocardial infarction). PCI itself was not a factor influencing long term outcomes (HR 0,75, 95% CI 0,51–1,1, p=0,15). Cox regression analysis revealed that prior stroke, ejection fraction, ICD and beta-blockers were the factors influencing survival (figure 1). Conclusions The analysis shows that PCI is a viable treatment option in the elderly population and when indicated can be performed safely, with good short and long term results. Interventions such as ICD implantation or optimal medical therapy of HF should always be considered. Acknowledgement/Funding None

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