scholarly journals Octogenarian women with acute coronary syndrome present frailty and readmissions more frequently than men

2018 ◽  
Vol 8 (3) ◽  
pp. 252-263 ◽  
Author(s):  
Lourdes Vicent ◽  
Albert Ariza-Solé ◽  
Oriol Alegre ◽  
Juan Sanchís ◽  
Ramón López-Palop ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Poor Prognosis ◽  
Prior History ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Female Sex ◽  
St Segment ◽  
History Of ◽  
Elevation Acute Coronary Syndrome ◽  
Artery Disease

Background: A worse prognosis has been reported among women with acute coronary syndrome compared to men. Our aim was to address the role of frailty and sex in the management and prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome. Methods: A prospective registry in 44 Spanish hospitals including patients aged 80 years and older with non-ST-segment elevation acute coronary syndrome. Frailty assessment was performed using the FRAIL scale. Results: Of a total of 535 patients, 207 (38.7%) were women. Mean age was 84.8±4.0 years, similar in men and women. A prior history of coronary artery disease was more common in men (146, 44.9%) than in women (46, 22.2%), P<0.001. Frailty was less frequent in men (65, 20.2%) than in women (77, 37.8%), P<0.001. Female sex was an independent predictor of death/hospitalisation (hazard ratio (HR) 1.7, 95% confidence interval (CI) 1.1–2.4) and of hospitalisation at 6 months (HR 1.6, 95% CI 1.04–2.4). In men, compared to non-frail patients, both a prefrail status (HR 3.47, 95% CI 1.22–9.89) and frailty (HR 3.19, 95% CI 1.08–9.43) were independently associated with higher mortality. In women only frailty was independently associated with higher mortality (HR 5.68, 95% CI 1.91–16.18, compared to prefrailty or robustness). Frailty was associated with readmissions in men (HR 3.34, 95% CI 1.79–6.22) but not in women. Conclusions: In octogenarians with acute coronary syndrome female sex was independently associated with death/hospitalisation at 6 months. Frailty was more common in women and was a predictor of poor prognosis. In men prefrailty also predicted a poor prognosis.

Relation of vascular dilator function and cardiac autonomic function with coronary angiography findings in patients with non-ST segment elevation acute coronary syndrome

2020 ◽  
pp. 204887262091871
Author(s):  
Gaetano Antonio Lanza ◽  
Eleonora Ruscio ◽  
Gessica Ingrasciotta ◽  
Tamara Felici ◽  
Monica Filice ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Obstructive Coronary Artery Disease ◽  
Cardiac Autonomic Function ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Elevation Acute Coronary Syndrome ◽  
Artery Disease

Background A sizeable number of patients with a diagnosis of non-ST segment elevation acute coronary syndrome show non-obstructive coronary artery disease. In this study we assessed whether differences in vascular and cardiac autonomic function exist between non-ST segment elevation acute coronary syndrome patients with obstructive or non-obstructive coronary artery disease. Methods and results Systemic endothelium-dependent and independent vascular dilator function (assessed by flow-mediated dilation and nitrate-mediated dilation of the brachial artery, respectively) and cardiac autonomic function (assessed by time-domain and frequency-domain heart rate variability parameters) were assessed on admission in 120 patients with a diagnosis of non-ST segment elevation acute coronary syndrome. Patients were divided into two groups according to coronary angiography findings: (a) 59 (49.2%) with obstructive coronary artery disease (≥50% stenosis in any epicardial arteries); (b) 61 (50.8%) with non-obstructive coronary artery disease. No significant differences between the two groups were found in both flow-mediated dilation (5.03 ± 2.6 vs. 5.40 ± 2.5%, respectively; P = 0.37) and nitrate-mediated dilatation (6.79 ± 2.8 vs. 7.30 ± 3.4%, respectively; P = 0.37). No significant differences were also observed between the two groups both in time-domain and frequency-domain heart rate variability variables, although the triangular index tended to be lower in obstructive coronary artery disease patients (30.2 ± 9.5 vs. 33.9 ± 11.6, respectively; P = 0.058). Neither vascular nor heart rate variability variables predicted the recurrence of angina, requiring emergency room admission or re-hospitalisation, during 11.3 months of follow-up. Conclusions Among patients admitted with a diagnosis of non-ST segment elevation acute coronary syndrome we found no significant differences in systemic vascular dilator function and cardiac autonomic function between those with obstructive coronary artery disease and those with non-obstructive coronary artery disease.

scholarly journals ST Segment Depression in 12 lead ECG and Severity of Coronary Artery Disease in Non-ST segment elevation Acute Coronary Syndrome

2017 ◽  
Vol 9 (2) ◽  
pp. 116-121
Author(s):  
Mohammad Emdadul Hoque Miah ◽  
Abul Hussain Khan Chowdhury ◽  
Khandaker Qamrul Islam ◽  
Mir Jamaluddin ◽  
Shakil Ghafur ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Positive Correlation ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
Elevation Acute Coronary Syndrome ◽  
Artery Disease ◽  
Vessel Score

Background: Patients of non-ST segment elevation acute coronary syndrome (NSTE ACS) is a large group who gets admitted in coronary care units. 12-lead electrocardiogram (ECG) provides the simple available and earliest objective information for risk stratification of NSTEACS. We tried to find out the association between magnitude of ST segment depression and angiographic severity in NSTE ACS patients.Methods: This cross sectional study was carried out in patients with NSTE ACS patients admitted into and underwent coronary angiography. A total number of 105 consecutive patients were included in this study. ST segment depression was measured and categorized according to magnitude of ST segment depression into three groups as Group I: No (<1mm) ST segment depression, Group II: 1-2 mm ( e”1 to <2mm) ST segment depression and Group III: e” 2 mm ST segment depression. Cumulative sum of ST segment depression and number of leads in ST segment depression also measured in all ECG leads. Angiographic severity was assessed by vessel score and Friesinger index. Significant CAD was considered if Friesinger index was e” 5. Magnitude of ST segment depression was correlated with angiographic severity of coronary artery disease.Results: According to ‘Friesinger index’ 56(53.33%) patients had significant CAD and 49(46.66%) patients had insignificant CAD. Magnitude of ST segment depression found to have significant relationship with severity of coronary artery disease (p<0.001). Number of leads in ST segment depression also revealed positive correlation (r = 0.446; p<0.001). Positive correlation was also found between sum of the ST segment depression and Vessel score (r= 0.435; p<0.001).Conclusion: Magnitude of ST segment depression is positively correlated with the angiographic severity of coronary artery disease in non- ST segment elevation acute coronary syndrome.Cardiovasc. j. 2017; 9(2): 116-121

scholarly journals Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome

2021 ◽  
Vol 10 (19) ◽  
pp. 4403
Author(s):  
Pablo Díez-Villanueva ◽  
Jose María García-Acuña ◽  
Sergio Raposeiras-Roubin ◽  
Jose A. Barrabés ◽  
Alberto Cordero ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Elderly Women ◽  
Prior History ◽  
Invasive Approach ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
History Of ◽  
Elevation Acute Coronary Syndrome ◽  
One Year

Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p < 0.001) and more often had a history of hypertension (77% vs. 83.1%, p < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78; p < 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14; p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men.

scholarly journals Inpatient- versus Outpatient-Onset Acute Coronary Syndrome: Comparison of Clinical Features and Outcomes

2018 ◽  
Vol 45 (3) ◽  
pp. 136-143
Author(s):  
Kamran Zafar ◽  
Nirav Patil
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Intervention ◽  
Premature Coronary Artery Disease ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment ◽  
History Of ◽  
Hospital Stays ◽  
Artery Disease ◽  
Onset Group

The clinical characteristics and outcomes among patients with inpatient-onset non-ST-segment-elevation acute coronary syndrome have not been fully investigated. Therefore, we conducted a retrospective single-center analysis of patients who were ≥18 years old and diagnosed with acute coronary syndrome at our hospital during 2014. We performed logistic regression analysis to evaluate outcomes and made adjustments for age, race, family history of premature coronary artery disease, and comorbidities. Our search through 31,274 hospital discharge records identified 683 cases of acute coronary syndrome: 32 were inpatient-onset and 651 were outpatient-onset. The inpatient-onset group was older (74.6 ± 9.6 vs 64 ± 12.8 yr; P &lt;0.001), and patients were more likely to be black (28.1% vs 12.9%). Diagnoses at admission in the inpatient-onset group varied widely, including 4 cases of pneumonia and 3 of intestinal obstruction. The inpatient-onset group was less likely than the outpatient-onset group to undergo cardiac catheterization (34.4% vs 90.2%; adjusted odds ratio [AOR], 0.11; 95% CI, 0.05–0.28; P &lt;0.001) or percutaneous coronary intervention (12.5% vs 61.6%; AOR, 0.16; 95% CI, 0.05–0.48; P=0.001), or to be discharged from the hospital (53.1% vs 88.9%; AOR, 0.26; 95% CI, 0.11–0.6; P=0.002). The inpatient-onset ACS group had longer hospital stays than did the outpatient-onset group (9.9 ± 8.9 vs 6.4 ± 5.2 d; P=0.03). We found that inpatient-onset acute coronary syndrome was associated with less interventional management, a longer hospital stay, and a lower likelihood of discharge to home.

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