scholarly journals In-hospital bleeding in elderly patients with acute coronary syndrome: are potent antiplatelet agents safe?

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K Keskin ◽  
S Sigirci ◽  
A Gurdal ◽  
M Sumerkan ◽  
O S Ser ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Urinary Tract ◽  
Elderly Patients ◽  
Kidney Injury ◽  
Antiplatelet Agents ◽  
Bleeding Events ◽  
Access Site ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Associated Risk Factors

Abstract Background Despite implementation of newer interventional techniques and therapeutic advances, elderly patients with acute coronary syndrome continue to be prone to in-hospital bleeding compared to their younger patients. Purpose To investigate in-hospital bleeding events, define the bleeding sites, characteristics and associated factors in elderly patients with acute coronary syndrome. Methods Patients 75 years or over who were admitted with acute coronary syndrome were included in the study. The definition of in-bleeding was defined as any bleeding requiring transfusion or clinically significant bleeding that altered the treatment course. The main outcome of the study was to find out the incidence of in-hospital bleeding events and associated risk factors. We also wanted to define the bleeding sites, characteristics as well as 1-year all-cause mortality with respect to in-hospital bleeding. Results Overall, 539 patients were included in the study. Mean age was 82.5±4.8 years and 282 (52.3%) patients were female. Of these patients 69 (12.8%) developed in-hospital bleeding. The most common site for bleeding was urinary tract followed by access site bleeding. Factors that were independently related with in-hospital bleeding were age (OR: 1.08; 1.01–1.14 CI 95%; p=0.01), acute kidney injury (OR: 3.66; 2.01–6.69 CI 95%; p<0.01), tirofiban (OR: 4.43; 1.78–10.99 CI 95%; p<0.01) and ticagrelor (OR: 1.93; 1.01–3.73 CI 95%; p=0.04) administration. The patients who developed in-hospital bleeding had also higher one-year all-cause mortality (p [log-rank] = 0.01). Conclusion In-hospital bleeding continues to be a frequent problem among older patients with acute coronary syndrome. Ticagrelor and tirofiban should be used cautiously. In addition to access site bleeding, urinary tract bleeding events were also common. FUNDunding Acknowledgement Type of funding sources: None. Table 1 Table 2

scholarly journals J-shaped relationship between admission diastolic blood pressure and 2-year cardiovascular mortality in elderly patients with acute coronary syndrome

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
C Jiang ◽  
S Wu ◽  
M Wang ◽  
H Li ◽  
X Zhao
Keyword(s):  
Blood Pressure ◽  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Diastolic Blood Pressure ◽  
Lower Risk ◽  
Cox Regression ◽  
Cardiovascular Death ◽  
Coronary Syndrome ◽  
All Cause Mortality

Abstract Objective To investigate the relationship between admission diastolic blood pressure (DBP) and subsequent cardiovascular and all-cause mortality in elderly patients with acute coronary syndrome (ACS). Methods This is a retrospective observational study. Consecutive patients ≥65 years of age admitted for ACS at a 2,300-bed tertiary hospital from December 2012 to July 2019 were included. The association between admission DBP and cardiovascular and all-cause mortality during hospitalization and over the follow-up period among this population were analyzed using multivariate COX regression model. Results were presented according to DBP quartiles: Q1, less than 67 mm Hg; Q2, from 67 to 72 mm Hg; Q3, from 73 to 80 mm Hg; and Q4, above 80 mm Hg. Results A total of 6 785 patients were included in this cohort study. Mean (SD) patient age was 74.0 (6.5) years, and 47.6% were women. Mean (SD) follow-up time was 2.54 (1.82) years. A non-linear relation was observed between DBP at admission and cardiovascular and all-cause mortality during hospitalization and over the follow-up period using restricted cubic splines. After adjustment for potential confounders, patients in Q3 or Q2 had lower risk for 2-year cardiovascular death by Cox proportional hazard model compared with patients in Q4 (hazard ratio [HR] 0.66; 95% confidence interval [CI], 0.48–0.90, P=0.010, for Q3 vs Q4; and HR 0.72; 95% CI, 0.53–0.99, P=0.041, for Q2vs Q4), while patients in Q1 had similar risk for cardiovascular death with that of patients in Q4. Meanwhile, when compared with patients in Q1, patients in Q3 had lower risk for 2-year cardiovascular death (HR, 0.72; 95% CI, 0.53–0.97, P=0.033). However, lower or higher admission DBP was not an independent predictor of 2-year all-cause mortality in this population. Conclusion Among patients aged ≥65 years admitted for ACS, there is a J-curve relationship between supine admission DBP and risk for 2-year cardiovascular death, with a nadir at 73–80 mm Hg. FUNDunding Acknowledgement Type of funding sources: Other. Main funding source(s): the Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Funding Support Study population and selection Adjusted multivariate COX regression

P3612Validation of Charlson Comorbidity Index to predict adverse events in elderly patients with Atrial Fibrillation and Acute Coronary Syndrome: an analysis from LONGEVO-SCA Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Esteve Pastor ◽  
E Marin ◽  
O Alegre ◽  
J C Castillo Dominguez ◽  
F Formiga ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Acute Coronary Syndrome ◽  
Adverse Events ◽  
Elderly Patients ◽  
Predictive Performance ◽  
Coronary Syndrome ◽  
C Statistic ◽  
All Cause Mortality ◽  
Comorbidity Index

Abstract Background Aging is frequently characterized by the coexistence of several comorbid conditions that increase the adverse prognosis during hospitalization. There are few scores to analyze the impact of comorbidities in prognosis. Charlson Comorbidity Index (CCI). This score evaluates the burden of comorbidity in general population but the influence within cardiac diseases is unknown. Purpose The aim of this study was to analyze the relationship of CCI in adverse outcomes at short-term follow-up in elderly patients with atrial fibrillation (AF) admitted after an acute coronary syndrome (ACS). Methods The prospective multicenter LONGEVO-SCA included unselected elderly patients hospitalized after non-STACS. In this substudy, we analyze the influence of comorbidities in elderly AF patients, comparing high quartiles of CCI (Q3-Q4: high burden of comorbidities) to low quartiles (Q1-Q2) and the predictive performance of adverse events at 6 months follow-up of CCI. Results We analyzed 531 patients (mean age 84.4±3.6 years; 322 (60.6%) male). 128 (24.1%) had AF diagnosis. 91 (71.1%) patients were classified into Q1-Q2 and 37 (28.9%) patients into Q3-Q4. We analyzed the association of clinical factors and adverse events and, after Cox multivariate regression analysis, CCI was independently associated with readmissions [HR 1.19, 95% CI (1.02–1.39); p=0.020) and all-cause mortality [HR 1.32, 95% CI (1.09–1.59); p=0.003]. Patients into Q3-Q4 had higher risk of mortality than patients into Q1-Q2 [HR 5.52, 95% CI (1.01–30.3); p=0.049]. Kaplan Meier analysis showed that AF patients into Q3-Q4 had significantly worse prognosis during the follow-up with high risk of all-cause mortality (p=0.034) and readmissions due to ACS (p=0.027). We observed good predictive performance of CCI for mortality (c-statistic 0.705; p<0.001) and modest predictive performance for readmissions (c-statistic 0.627; p<0.001). Event Free Survival according Charlson Conclusions Patients into high quartiles of CCI had higher risk of adverse events during the follow-up. CCI was an independent predictor of all-cause mortality and readmissions in elderly patients. Indeed, this is the first time to validate CCI to predict adverse events in AF patients with ACS.

Acute Kidney Injury in Elderly Patients With Non-ST Elevation Acute Coronary Syndrome

Angiology ◽  
2015 ◽  
Vol 66 (9) ◽  
pp. 826-830 ◽  
Author(s):  
Anna Toso ◽  
Stefano De Servi ◽  
Mario Leoncini ◽  
Nuccia Morici ◽  
Ernesto Murena ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Kidney Injury ◽  
Coronary Syndrome ◽  
St Elevation ◽  
Elevation Acute Coronary Syndrome

scholarly journals Hyperuricemia is a Risk Factor for One-Year Overall Survival in Elderly Female Patients with Acute Coronary Syndrome

2020 ◽  
Vol 2020 ◽  
pp. 1-10 ◽  
Author(s):  
Shi Tai ◽  
Xuping Li ◽  
Zhaowei Zhu ◽  
Liang Tang ◽  
Hui Yang ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Elderly Patients ◽  
Independent Risk Factor ◽  
Female Patients ◽  
Coronary Syndrome ◽  
Elderly Female ◽  
All Cause Mortality ◽  
The Impact

Background. Hyperuricemia is a risk factor for cardiovascular diseases, but the impact of hyperuricemia and sex-related disparities is not fully clear in elderly patients with acute coronary syndrome (ACS). Objective. To investigate the association between hyperuricemia and 1-year all-cause mortality in elderly patients with ACS. Methods. This retrospective cohort study included 711 consecutive ACS patients aged ≥75 years, hospitalized in our center between January 2013 and December 2017. Serum uric acid (sUA), in-hospital events, and 1-year follow-up were analyzed. Multivariable logistic regression models were used to explore the risk factors for in-hospital events and 1-year all-cause mortality. Results. sUA levels were higher in males than in females (381.4 ± 110.1 vs. 349.3 ± 119.1 μmol/l, P<0.001). Prevalence of hypertension (80.5% vs. 72.6%, P=0.020), atrial fibrillation (16.2% vs. 9.5%, P=0.008), and severe heart failure (61.0% vs. 44.2%, P<0.001) were higher in patients with hyperuricemia than in patients with normal sUA. During the 1-year follow-up, 135 patients died (19.0%); all-cause mortality was higher in patients with hyperuricemia than in patients with normal sUA (23.1% vs. 16.7%, P=0.039). Hyperuricemia is related to in-hospital ventricular tachycardia and 1-year all-cause mortality (OR = 1.799, 95% CI 1.050–3.081, P=0.033; OR = 1.512, 95% CI 1.028–2.225, P=0.036, respectively). Multivariable regression analysis models showed that hyperuricemia was an independent risk factor of 1-year all-cause mortality in women (OR = 2.539, 95% CI 1.001–6.453, P=0.050), but not in men (OR = 0.931, 95% CI 0.466–1.858, P=0.839) after adjustment for confounding variables. Conclusions. Hyperuricemia is an independent risk factor for 1-year all-cause mortality in elderly female patients with ACS.

scholarly journals Comparison of Safety and Efficacy Between Clopidogrel and Ticagrelor in Elderly Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Xiangkai Zhao ◽  
Jian Zhang ◽  
Jialin Guo ◽  
Jinxin Wang ◽  
Yuhui Pan ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Meta Analysis ◽  
Adenosine Diphosphate ◽  
Cardiovascular Death ◽  
Minor Bleeding ◽  
Efficacy And Safety ◽  
Coronary Syndrome ◽  
All Cause Mortality ◽  
Receptor Inhibitor

Background: Dual antiplatelet therapy combining aspirin with a P2Y12 adenosine diphosphate receptor inhibitor is a therapeutic mainstay for acute coronary syndrome (ACS). However, the optimal choice of P2Y12 adenosine diphosphate receptor inhibitor in elderly (aged ≥65 years) patients remains controversial. We conducted a meta-analysis to compare the efficacy and safety of ticagrelor and clopidogrel in elderly patients with ACS. Methods: We comprehensively searched in Web of Science, EMBASE, PubMed, and Cochrane databases through 29th March, 2021 for eligible randomized controlled trials (RCTs) comparing the efficacy and safety of ticagrelor or clopidogrel plus aspirin in elderly patients with ACS. Four studies were included in the final analysis. A fixed effects model or random effects model was applied to analyze risk ratios (RRs) and hazard ratios (HRs) across studies, and I2 to assess heterogeneity.Results: A total number of 4429 elderly patients with ACS were included in this analysis, of whom 2170 (49.0%) patients received aspirin plus ticagrelor and 2259 (51.0%) received aspirin plus clopidogrel. The ticagrelor group showed a significant advantage over the clopidogrel group concerning all-cause mortality (HR 0.78, 95% CI 0.63–0.96, I2 = 0%; RR 0.79, 95% CI 0.66–0.95, I2 = 0%) and cardiovascular death (HR 0.71, 95% CI 0.56–0.91, I2 = 0%; RR 0.76, 95% CI 0.62–0.94, I2 = 5%) but owned a higher risk of PLATO major or minor bleeding (HR 1.46, 95% CI 1.13–1.89, I2 = 0%; RR 1.40, 95% CI 1.11–1.76, I2 = 0%). Both the groups showed no significant difference regarding major adverse cardiovascular events (MACEs) (HR 1.06, 95% CI 0.68–1.65, I2 = 77%; RR 1.04, 95% CI 0.69–1.58, I2 = 77%).Conclusion: For elderly ACS patients, aspirin plus ticagrelor reduces cardiovascular death and all-cause mortality but increases the risk of bleeding. Herein, aspirin plus ticagrelor may extend lifetime for elderly ACS patients compared with aspirin plus clopidogrel. The optimal DAPT for elderly ACS patients may be a valuable direction for future research studies.

P3840Impact of potent P2Y12 inhibitors in adverse events reduction in diabetic patients with Acute Coronary Syndromes. An analysis from ACHILLES Registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M A Esteve Pastor ◽  
J M Ruiz-Nodar ◽  
J M Rivera-Caravaca ◽  
E Orenes-Pinero ◽  
A Tello-Montoliu ◽  
...  
Keyword(s):  
Adverse Events ◽  
Major Bleeding ◽  
Antiplatelet Agents ◽  
Diabetic Patients ◽  
Bleeding Events ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome ◽  
High Prevalence ◽  
All Cause Mortality

Abstract Background Diabetic patients (DM) with an acute coronary syndrome (ACS) have a worse prognosis than non-diabetic patients. The new P2Y12 inhibitors, both ticagrelor and prasugrel, have shown efficacy in cardiovascular event reduction in patients with DM and ACS. Purpose The main objective of this study was to analyze the use of antiplatelet agents, prognosis and adverse events during the follow-up in diabetic patients admitted after an acute coronary syndrome. Methods These patients belong to ACHILLES registry. All patients with type 1 ACS were included prospectively in a national, prospective and multicenter registry. We analyzed baseline characteristics and comorbidities focusing on the presence of DM and the use of potent antiplatelet agents (ticagrelor and prasugrel) in those patients. After 1 year of follow-up, adverse events in diabetic patients were analyzed according to the type of antiplatelet used [clopidogrel vs new antiplatelet drugs (NAD)]. Results Of 1,717 patients, 1,294 patients [mean age 65.0±13.3 years, 952 (73.6%) male] were finally analyzed (excluding patients discharged with oral anticoagulation). Diabetic patients had high prevalence of cardiovascular risk factors such as hypertension (54.9% vs 81.1%; p<0.001), dyslipidemia (50.7% vs 72.8%; p<0.001) or chronic kidney disease (22.1% vs 31.9%; p<0.001). Diabetic patients had also higher rate of non-invasive management of ACS compared to non-diabetic patients (4.5% vs 9.1%; p=0.002). At discharge, the use of NAD in patients with DM was 40.4% compared to 50.8% in non-diabetic patients (p<0.001). After 1 year of follow-up, 64 (5.0%/year) patients had a new ACS, 46 (3.6%/year) patients died due to cardiovascular causes, 76 (6.1%/year) died for any cause and 28 (2.2%/year) patients had a major bleeding events. The use of clopidogrel in diabetic patients was associated with an increase in all-cause mortality [HR 2.90; 95% CI (1.27–6.629), p=0.011] and in MACE [HR 2.14; 95% CI (1.22–3.77), p=0.008.] Diabetic patients treated with NAD had no differences in terms of major bleeding but those patients presented a significant reduction in cardiovascular mortality and MACE with NAD use. Event Free Survival according NAD Use Conclusions Patients with DM and ACS had high prevalence of concomitant cardiovascular risk factors but lower use of NAD compared with non-diabetic patients, despite DM patients had greater baseline risk. The use of NAD therapy was associated with a significant reduction in all-cause mortality, cardiovascular mortality and MACE without differences in major bleeding events.

Temporal Trends and Outcomes Associated with Major Bleeding in Acute Coronary Syndromes: A Decade-Long Perspective from the Acute Coronary Syndrome Israeli Surveys 2000-2010

Cardiology ◽  
2015 ◽  
Vol 132 (3) ◽  
pp. 163-171 ◽  
Author(s):  
Avi Sabbag ◽  
Victor Guetta ◽  
Paul Fefer ◽  
Shlomi Matetzky ◽  
Shmuel Gottlieb ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Major Bleeding ◽  
Temporal Trends ◽  
Blood Pressure Level ◽  
Bleeding Events ◽  
Access Site ◽  
Systolic Blood Pressure Level ◽  
Invasive Approach ◽  
Coronary Syndrome ◽  
Increased Risk

Objectives: The implementation of an early invasive approach and the increased use of potent anti-thrombotic drugs have resulted in higher rates of major bleeding events (MBE) in patients with acute coronary syndrome (ACS). There are limited data on the temporal trends for the rates of MBE over the last decade and associated outcomes. Methods: Rates, characteristics, risk factors and clinical outcomes associated with MBE were assessed among 11,538 patients enrolled in the biennial Acute Coronary Syndrome Israeli Surveys (ACSIS) 2000-2010. Results: A total of 143 patients (1.2%) experienced MBE during the index hospitalization for ACS. There was a significant increase in the risk of MBE in the late (2006-2010) versus the early (2000-2004) surveys (0.9 and 1.6% respectively, adjusted OR 1.86, p < 0.001). In the multivariate analysis, factors independently associated with a significant increase in the risk of MBE included undergoing primary percutaneous coronary intervention (OR 2.21, p < 0.005), experiencing renal failure (OR 4.19, p < 0.001) and systolic blood pressure level at admission (OR 1.12, per 10- mm Hg decrement, p = 0.011). Patients who experienced MBE had a >3.5-fold increased risk for 1-year mortality (adjusted HR = 3.52, p < 0.001). Interestingly, the mortality risk associated with MBE was evident only among those who experienced non-access-site bleeding (HR = 1.9; p = 0.001). Conclusions: In the past decade, there has been a significant increase in the rate of MBE. However, we found that only major bleeding that was not related to the vascular access site affected subsequent mortality.

scholarly journals Definition of acute kidney injury impacts prevalence and prognosis in ACS patients undergoing coronary angiography

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Maren Weferling ◽  
Christoph Liebetrau ◽  
Daniel Kraus ◽  
Philipp Zierentz ◽  
Beatrice von Jeinsen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Acute Coronary Syndrome ◽  
Coronary Angiography ◽  
Mortality Risk ◽  
Outcome Measure ◽  
Kidney Injury ◽  
Coronary Syndrome ◽  
Strong Risk Factor ◽  
All Cause Mortality ◽  
Definition Of

Abstract Background Development of acute kidney injury (AKI) in invasively managed patients with acute coronary syndrome (ACS) is associated with a markedly increased mortality risk. Different definitions of AKI are in use, leading to varying prevalence and outcome measurements. The aim of the present study is to analyze an ACS population undergoing coronary angiography for differences in AKI prevalence and outcome using four established AKI definitions. Methods 944 patients (30% female) were enrolled in a prospective registry between 2003 and 2005 with 6-month all-cause mortality as outcome measure. Four established AKI definitions were used: an increase in serum creatinine (sCR) ≥ 1.5 fold, ≥ 0.3 mg/dl, and ≥ 0.5 mg/dl and a decrease in eGFR > 25% from baseline (AKIN 1, AKIN 2, CIN, and RIFLE definition groups, respectively). Results AKI rates varied widely between the different groups. Using the CIN definition, AKI frequency was lowest (4.4%), whereas it was highest if the RIFLE definition was applied (13.2%). AKIN 2 displayed a twofold higher AKI prevalence compared with AKIN 1 (10.2% vs. 5.3% (p < 0.001)). AKI was a strong risk factor for mid-term mortality, with distinctive variability between the definitions. The lowest mortality risk was found in the RIFLE group (HR 6.0; 95% CI 3.7–10.0; p < 0.001), whereas CIN revealed the highest risk (HR 16.7; 95% CI 9.9–28.1; p < 0.001). Conclusion Prevalence and outcome in ACS patients varied considerably depending on the AKI definition applied. To define patients with highest renal function-associated mortality risk, use of the CIN definition seems to have the highest prognostic relevance.

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