scholarly journals Acute coronary syndrome in elderly: aspects of patient management

The Clinician ◽  
2019 ◽  
Vol 13 (1-2) ◽  
pp. 19-26 ◽  
Author(s):  
Yu. D. Ryzhkova ◽  
E. V. Kanareykina ◽  
M. R. Atabegashvili ◽  
E. V. Konstantinova ◽  
M. Yu. Gilyarov
Keyword(s):  
Clinical Trials ◽  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Randomized Clinical Trials ◽  
The Elderly ◽  
Developed Countries ◽  
Interventional Treatment ◽  
Coronary Syndrome ◽  
Age Related ◽  
Related Association

Coronary heart disease is the leading cause of death worldwide. Over the past few decades, life expectancy has increased, which has led to an aging population in developed countries, so the average age of patients with acute coronary syndrome (ACS) has steadily increased in recent decades. The inclusion of elderly and senile patients in randomized clinical trials does not reflect the age-related association of these diseases. However, antithrombotic therapy and interventional treatment are the basis of treatment in patients with ACS of any age, including the elderly. For older patients, there may be a mismatch between chronological and biological age. The question of how close the treatment of elderly patients with ACS is to the level of current recommendations and whether it is possible to apply them unconditionally in this group of patients does not have a definite answer. Current recommendations and the underlying randomized clinical trials are focused on any one disease, whereas in the elderly in most cases multimorbid pathology occurs. In general, elderly patients with ACS should be treated using the same methods as younger patients, however, the presence of comorbid diseases in an elderly patient naturally increases the risk of complications, makes the patient’s prognosis heavier, significantly affects treatment tactics, limits the possibility of using conventional approaches when choosing a drug therapy.

scholarly journals Acute Coronary Syndrome in Octogenerians: Management Perspectives

2020 ◽  
pp. 1-4
Author(s):  
Ranjan Modi ◽  
Sunil Modi ◽  
Ranjan Modi
Keyword(s):  
Clinical Trials ◽  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Medical Therapy ◽  
Randomized Clinical Trials ◽  
Coronary Syndrome ◽  
Younger Age ◽  
Current Guidelines ◽  
Term Data

Current guidelines for acute coronary syndrome are derived from the data in randomized clinical trials and metanalysis conducted in patients. These patients are generally of younger age. The data of acute coronary syndrome in octogenarians is mainly derived from registries. This mid and long-term data regarding medical therapy or interventions in octogenarians is low in number with smaller subsets of patients. Most of the physicians are reluctant to use the same guidelines in these elderly patients due to increased chances of complications. This article reviews the available data and literature in acute coronary syndrome in octogenarians and provides management perspectives for these elderly patients.

scholarly journals How Does the Presence of Diabetes Affect the Course of Acute Coronary Syndrome in Elderly Patients in Actual Clinical Practice?

2019 ◽  
Vol 15 (1) ◽  
pp. 29-35
Author(s):  
M. R. Atabegashvili ◽  
E. V. Konstantinova ◽  
M. D. Muksinova ◽  
A. E. Udovichenko ◽  
A. P. Nesterov ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
The Elderly ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Vessel Disease ◽  
Previous Stroke ◽  
Significant Difference ◽  
Group 2 ◽  
Student’S T

The number of elderly patients with diabetes mellitus (DM) is constantly growing in general population. Accordantly, we have the growth of such patients in the group of acute coronary syndrome (ACS).Aim.To compare clinical characteristics of the elderly patient (>75 years old) with and without DM.Material and methods. This retrospective study included 1133 ACS patients who were aged ≥75 years and admitted to the City Clinical Hospital №1 from 01.01.2015 to 31.12.2016. Median age was 80 years, 66% were women. We analyzed 4 patient subgroups: Group 1 – 105 patients with ST-segment elevation myocardial infarction (STEMI) and DM, Group 2 – 254 STEMI patients without DM, Group 3 – 222 non-STEMI patients with DM and Group 4 – 552 non-STEMI patients without DM. We used Student’s t-test and c2 tests to find significant difference between pairs of groups.Results. Median age of patients in 4 groups was 80, 81, 81 and 80 years (p>0.05), age variance was 75-100 years. DM was found in 29% of all elderly patients with no difference between STEMI and non-STEMI groups. STEMI and non-STEMI patients with DM were more likely women. NonSTEMI patients with DM more often had hypertension, previous stroke, lower median Hb (121 vs 127 g/l; p<0.001). Angiography data demonstrated more often three-vessel disease (43% vs 29.7%) and less one-vessel disease (15% vs 25.6%; p<0.05) between groups 3 and 4. Glomerular filtration rate (GFR) <60 ml/min/1.73 m2 occurred in 74%, 73%, 77% and 74% in patients of 4 groups (p>0,05), but GFR<45 ml/min/1.73 m2 was more prevalent in patients with DM than without DM: 45%, 39%, 45%, 36% in 4 groups. Finally, mortality rates didn’t demonstrate significant difference between DM and non-DM patients with STEMI (10% vs 13%; p>0.05) and non-STEMI (7% vs 7%) groups.Conclusion. DM is associated with ACS approximately in one third of the elderly patients and is not associated with its type (STEMI or non-STEMI). In STEMI and non-STEMI patients the female sex and GFR level <45 ml/min/1.73 m2 were associated with DM. In non-STEMI group multi-vessel disease and presence of hypertension and previous stroke were associated with DM. We didn’t find any difference between mortality in elderly patients with and without DM. 

Clinical Impact of Valvular Heart Disease in Elderly Patients Admitted for Acute Coronary Syndrome: Insights From the Elderly-ACS 2 Study

2020 ◽  
Vol 36 (7) ◽  
pp. 1104-1111 ◽  
Author(s):  
Gabriele Crimi ◽  
Claudio Montalto ◽  
Luca Angelo Ferri ◽  
Luigi Piatti ◽  
Irene Bossi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Elderly Patients ◽  
Valvular Heart Disease ◽  
The Elderly ◽  
Clinical Impact ◽  
Coronary Syndrome

P1558Clinical utility of the PRECISE-DAPT score in the prediction of hemorrhagic events in elderly patients with acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Rioboo ◽  
E Abuassi Alnakeeb ◽  
S Raposeiras Roubin ◽  
I Munoz Pousa ◽  
M Cespon Fernandez ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Elderly Patients ◽  
Age Groups ◽  
Bleeding Event ◽  
Bleeding Risk ◽  
The Elderly ◽  
Coronary Syndrome ◽  
Risk Of Bleeding ◽  
Risk Patients

Abstract Introduction The clinical utility and validity of the PRECISE-DAPT bleeding risk score for elderly patients with acute coronary syndrome (ACS) is unknown. We investigated the previous aspect in a contemporary population treated with percutaneous coronary intervention (PCI) and dual antiplatelet therapy (DAPT) at discharge. Methods Retrospectively, from 2010 to 2016, we studied 3,814 consecutive patients with the diagnosis of ACS. All patients were treated with in-hospital PCI and DAPT at discharge. Elderly was defined if patients aged ≥75 years. Patients were categorized into three risk strata according to their PRECISE-DAPT score (very low-low: <17 points, moderate: 18–24 points, and high risk: ≥25 points). We included the first bleeding event occurred during the first year after discharge. Bleeding events were defined according to the BARC classification system, and divided into two subgroups: BARC 2–5 and BARC 3–5. The ability to separate high bleeding risk patients from lower bleeding risk patients was checked by the cumulative incidence function curves and compared using the Fine-Gray test, thus adjusting for death (non-bleeding related) as a competing risk. Discrimination (C statistic) and calibration (Hosmer-Lemeshow test) were used to test the predictive capacity of the score in pts aged ≥75 years and <75 years. Results 25.2% (n=961/3814) were ≥75 years old, 38.4% of them were women. DAPT duration was 11.5 (interquartile range [IQR] 2.5–13.7) vs. 12.0 (RIQ 8.2–14.1) months in the elderly vs. younger; (p<0.001). 92.5% (n=889) of the elderly were at high risk of bleeding (PRECISE-DAPT≥25 points), compared to 21.3% (n=607) of the youngest. The incidence of BARC 2–5 and BARC 3–5 was 7.4% and 2.7% in the elderly compared to 5.1% and 1.4% among the younger patients (p<0.001). The figure shows the ability of the PRECISE-DAPT score at capturing the risk of BARC 2–5 bleeding (panel A and B), in both age groups. Using the cut-off point ≥25, the effect in the prediction of BARC 2–5 bleeding and BARC 3–5 did not differ significantly between the elderly and those <75 years: sHR = 1.9 (95% CI: 1.2–6.00) in the elderly vs. 1.8 (95% CI: 1.3–2.5) in the other group (p=0.99) and sHR = 3.3 (95% CI: 1.9–6.0) vs. 3.6 (95% CI: 1.9–6.7) (p=0.83), respectively. There were no significant differences between the elderly and those under 75 years in terms of statistical C values either for BARC 2–5 bleeding (0.60 vs. 0.58) or BARC 3–5 bleeding (0.64 vs. 0.67). The score performed well in term of calibration in both groups (all p-values >0.3). Conclusion Although the use of PRECISE-DAPT resulted in classifying the majority of elderly patients at high risk of bleeding and despite exhibiting modest discriminative power, it performed well at classifying patients according to their risk of 1-year out-of-hospital bleeding in both age groups. PRECISE-DAPT appears to identify the truly low risk patients among the elderly, as compared to the younger group.

scholarly journals 70 Clinical outcomes of clopidogrel versus ticagrelor in the elderly patients with acute coronary syndrome

Heart ◽  
2017 ◽  
Vol 103 (Suppl 5) ◽  
pp. A52.2-A52 ◽  
Author(s):  
Lampson Fan ◽  
Asad Shabbir ◽  
Stewart Mclure ◽  
Jocelyn Lam ◽  
Mark Cassar ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Clinical Outcomes ◽  
The Elderly ◽  
Coronary Syndrome

scholarly journals ANTIPLATELET THERAPY OF ACUTE CORONARY SYNDROME: CURRENT CAPAB ILITIES

The Clinician ◽  
2018 ◽  
Vol 12 (1) ◽  
pp. 10-16
Author(s):  
E. V. Konstantinova ◽  
М. Yu. Gilyarov ◽  
N. А. Shostak ◽  
D. A. Anichkov
Keyword(s):  
Clinical Trials ◽  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Statistical Power ◽  
Randomized Clinical Trials ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Careful Analysis ◽  
Level Of Evidence ◽  
Coronary Syndrome

Dual antiplatelet therapy (acetylsalicylic acid and platelet P2Y12 receptor antagonist) is a standard component of treatment of any type of acute coronary syndrome, independently of perfusion and the chosen treatment strategy. Due to certain limitations of clopidogrel as the 2nd component of dual antiplatelet therapy in patients with acute coronary syndrome and percutaneous coronary intervention, the possibility of using prasugrel or ticagrelor should be considered first. Their effectiveness is higher than clopidogrel’s, as was demonstrated in large clinical trials. As a result, prasugrel and ticagrelor were included in all major international and Russian guidelines on treatment of this category of patients with the same class and level of evidence. Currently, there’re no data from any finished large randomized clinical trials of sufficient statistical power directly comparing the effectiveness and safety of prasugrel and ticagrelor. Therefore, careful analysis of the accumulated data on the safety and effectiveness of each drug including meta-analyses and registries is necessary for providing the best care for every individual patient.

scholarly journals Telomerase Activation to Reverse Immunosenescence in Elderly Patients With Acute Coronary Syndrome: Protocol for a Randomized Pilot Trial (Preprint)

2020 ◽  
Author(s):  
Rebecca Maier ◽  
Bilal Bawamia ◽  
Karim Bennaceur ◽  
Sarah Dunn ◽  
Leanne Marsay ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
European Union ◽  
Clinical Trials ◽  
T Cells ◽  
Acute Coronary Syndrome ◽  
Elderly Patients ◽  
Endothelial Function ◽  
Telomere Length ◽  
Pilot Trial ◽  
Coronary Syndrome

BACKGROUND Inflammation plays a key role in the pathophysiology of coronary heart disease (CHD) and its acute manifestation, acute coronary syndrome (ACS). Aging is associated with a decline of the immune system, a process known as immunosenescence. This is characterized by an increase in highly proinflammatory T cells that are involved in CHD progression, plaque destabilization, and myocardial ischemia–reperfusion injury. Telomere dysfunction has been implicated in immunosenescence of T lymphocytes. Telomerase is the enzyme responsible for maintaining telomeres during cell divisions. It has a protective effect on cells under oxidative stress and helps regulate flow-mediated dilation in microvasculature. OBJECTIVE The TACTIC (Telomerase ACTivator to reverse Immunosenescence in Acute Coronary Syndrome) trial will investigate whether a telomerase activator, TA-65MD, can reduce the proportion of senescent T cells in patients with ACS with confirmed CHD. It will also assess the effect of TA-65MD on decreasing telomere shortening, reducing oxidative stress, and improving endothelial function. METHODS The study was designed as a single-center, randomized, double-blind, parallel-group, placebo-controlled phase II trial. Recruitment started in January 2019. A total of 90 patients, aged 65 years or older, with treated ACS who have had CHD confirmed by angiography will be enrolled. They will be randomized to one of two groups: TA-65MD oral therapy (8 mg twice daily) or placebo taken for 12 months. The primary outcome is the effect on immunosenescence determined by a decrease in the proportion of CD8+ TEMRA (T effector memory cells re-expressing CD45RA [CD45 expressing exon A]) cells at 12 months. Secondary outcomes include leukocyte telomere length, endothelial function, cardiac function as measured by echocardiography and NT-proBNP (N-terminal fragment of the prohormone brain-type natriuretic peptide), systemic inflammation, oxidative stress, and telomerase activity. RESULTS The study received National Health Service (NHS) ethics approval on August 9, 2018; Medicines and Healthcare products Regulatory Agency approval on October 19, 2018; and NHS Health Research Authority approval on October 22, 2018. The trial began recruiting participants in January 2019 and completed recruitment in March 2020; the trial is due to report results in 2021. CONCLUSIONS This pilot trial in older patients with CHD will explore outcomes not previously investigated outside in vitro or preclinical models. The robust design ensures that bias has been minimized. Should the results indicate reduced frequency of immunosenescent CD8+ T cells as well as improvements in telomere length and endothelial function, we will plan a larger, multicenter trial in patients to determine if TA-65MD is beneficial in the treatment of CHD in elderly patients. CLINICALTRIAL ISRCTN Registry ISRCTN16613292; http://www.isrctn.com/ISRCTN16613292 and European Union Drug Regulating Authorities Clinical Trials Database (EudraCT), European Union Clinical Trials Register 2017-002876-26; https://tinyurl.com/y4m2so8g INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19456

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