Should Percutaneous Coronary intervention be the Standard Treatment Strategy for Significant Coronary Artery Disease in all Octogenarians?.

2020 ◽  
Vol 16 ◽  
Author(s):  
George Kassimis ◽  
Grigoris V. Karamasis ◽  
Athanasios Katsikis ◽  
Joanna Abramik ◽  
Nestoras Kontogiannis ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Symptom Relief ◽  
Coronary Intervention ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Artery Disease

Coronary artery disease (CAD) remains the leading cause of cardiovascular death in octogenarians. This group of patients represents nearly a fifth of all patients treated with percutaneous coronary intervention (PCI) in real-world practice. Octogenarians have multiple risk factors for CAD and often greater myocardial ischemia than younger counterparts, with a potential of an increased benefit from myocardial revascularization. Despite this, octogenarians are routinely under-treated and belittled in clinical trials. Age does make a difference to PCI outcomes in older people, but it is never the sole arbiter of any clinical decision, whether in relation to the heart or any other aspect of health. The decision when to perform revascularization in elderly patients and especially in octogenarians is complex and should consider the patient on an individual basis, with clarification of the goals of the therapy and the relative risks and benefits of performing the procedure. In ST-segment elevation myocardial infarction (MI), there is no upper age limit regarding urgent reperfusion and primary PCI must be the standard of care. In non-ST-segment elevation acute coronary syndromes, a strict conservative strategy must be avoided; whereas the use of a routine invasive strategy may reduce the occurrence of MI and need for revascularization at follow-up, with no established benefit in terms of mortality. In stable CAD patients, invasive therapy on top of the optimal medical therapy seems better in symptom relief and quality of life. This review summarizes the available data on percutaneous revascularization in the elderly patients and particularly in octogenarians, including practical considerations on PCI risk secondary to ageing physiology. We also analyse technical difficulties met when considering PCI in this cohort and the ongoing need for further studies to ameliorate risk stratification and eventually outcomes in these challenging patients.

scholarly journals Clopidogrel and Ticagrelor Do Not Influence Platelet Indices After Percutaneous Coronary Intervention

2020 ◽  
Vol 25 (4) ◽  
pp. 35-37
Author(s):  
Ioana Șuş ◽  
Laszlo Hadadi ◽  
Cristina Somkereki ◽  
Dan Dobreanu
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Platelet Indices ◽  
St Segment Elevation ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Artery Disease

Abstract Platelet indices have been linked to the severity and prognosis of coronary artery disease, but a very small number of studies assessed them under dual antiplatelet therapy after percutaneous coronary intervention (PCI). The aim of this study was to evaluate changes in mean platelet volume (MPV), platelet distribution width (PDW) and platelet-large cell ratio (P-LCR) in these patients. A number of 437 patients with stable coronary artery disease, 131 patients with non ST segment elevation acute coronary syndrome and 151 patients with ST segment elevation myocardial infarction were included in the study. There was no difference between the three groups regarding platelet indices prior to PCI. Follow-up data was available for 181 patients, at a mean follow-up time of 69 (46-98) days. MPV, PDW and PLC-R were similar to those prior to PCI in all three groups. Regarding the P2Y12 inhibitor, clopidogrel or ticagrelor, there was no difference at follow-up between platelet indices irrespective of the indication for PCI.

scholarly journals Association of Frailty With Antiplatelet Response Among Elderly Chinese Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

2020 ◽  
Vol 26 ◽  
pp. 107602962091599
Author(s):  
Yang Liu ◽  
Shaoyan Liu ◽  
Keyu Wang ◽  
Hongbin Liu
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Independent Predictor ◽  
Coronary Intervention ◽  
Light Transmittance ◽  
Platelet Response ◽  
Percutaneous Coronary ◽  
Artery Disease

Frailty has been implicated as a prognostic factor for ischemic cardiovascular diseases. However, the effects of frailty on platelet responses to aspirin and clopidogrel remain under investigation. In this study, we enrolled consecutive elderly patients with coronary artery disease (CAD) who were treated by percutaneous coronary intervention (PCI) to evaluate this association. A total of 264 patients (aged 70-95 years) were included. Patients were divided into 2 groups: a nonfrail (nFR) group and a frail (FR) group according to the Clinical Frailty Scale. Platelet reactivity was assessed with a light transmittance aggregometry method, and arachidonic acid and adenosine diphosphate induced maximum platelet aggregation (AA-MPA/ADP-MPA) were calculated to evaluate the platelet response to aspirin and clopidogrel. The results showed that the AA-MPA and ADP-MPA of the FR group were significantly higher than those in the nFR group (17.49 ± 6.65 vs 15.19 ± 6.33, P < .01; 56.13 ± 10.14 vs 45.45 ± 11.59, P < .01). High on-aspirin platelet response (HAPR) and high on-clopidogrel platelet response (HCPR) were significantly more common in the FR group than in the nFR group (24.67% vs 13.16%, P = .028, 37.33% vs 15.79%, P < .01). According to multivariable regression analyses, frailty was found to be independently associated with AA-MPA (βcoefficient = 1.883, P = .042) and ADP-MPA (βcoefficient = 9.287, P < .001), and it was an independent predictor of HAPR (odds ratio [OR]: 2.696, P < .01) and HCPR (OR: 2.543, P < .01). It was concluded that among elderly patients with CAD undergoing PCI, frailty is an independent predictor of HAPR and HCPR, and the state of frailty is independently associated with the platelet responses to clopidogrel and aspirin.

scholarly journals Serum sclerostin and adverse outcomes in elderly patients with stable coronary artery disease undergoing percutaneous coronary intervention

2019 ◽  
Vol 32 (10) ◽  
pp. 2065-2072
Author(s):  
Wuyang He ◽  
Chunqiu Li ◽  
Qingwei Chen ◽  
Tingting Xiang ◽  
Peng Wang ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Stable Coronary Artery Disease ◽  
Coronary Intervention ◽  
Adverse Outcomes ◽  
Percutaneous Coronary ◽  
Artery Disease ◽  
Prognostic Power

Abstract Background Recently, sclerostin, a bone-derived protein, has been shown to play a key role in atherosclerosis progression. However, few studies have investigated the influence of sclerostin on cardiovascular disease prognosis. We investigated the relationship between serum sclerostin levels and adverse outcomes in elderly patients with stable coronary artery disease (SCAD) who were undergoing percutaneous coronary intervention (PCI). Methods We enrolled 310 elderly SCAD patients who underwent PCI in this study and followed them 3 years. According to the median serum sclerostin levels, subjects were stratified into a low sclerostin (low scl) group (n = 144) and a high sclerostin (high scl) group (n = 166). Time-to-event analyses were performed with the Kaplan–Meier method. Associations between sclerostin levels and main adverse cardiovascular and cerebrovascular events (MACCEs) and mortality were evaluated by Cox multivariate regression analysis. The prognostic power of predictive models was verified by the concordance index and receiver operating characteristic curve analysis. Results The high scl group had a significantly higher MACCE-free rate and better survival than the low scl group. Serum sclerostin was an independent predictor and could improve the prognostic power for adverse outcomes. In addition, serum sclerostin levels were significantly associated with bone turnover markers, a lower presence of multivessel disease and a lower CCS angina class. Conclusions Serum sclerostin is a prognostic parameter for predicting and intervening in the adverse outcomes of elderly SCAD patients undergoing PCI, which may be explained by its potential role in the bone–vascular axis.

scholarly journals Prinzmetal angina in a patient with previous coronary artery disease.Topic review and case report

2021 ◽  
Vol 29 ◽  
pp. 1-6
Author(s):  
Débora Rocha ◽  
Leonardo Amaral ◽  
Pedro Borges ◽  
Flavio Barbosa ◽  
Ana Nogueira ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Case Report ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
St Segment ◽  
Percutaneous Coronary ◽  
Electrocardiographic Changes ◽  
Coronary Procedures ◽  
Artery Disease

Prinzmetal angina is described as episodes of chest pain that occur at rest, associated with electrocardiographic changes in the ST-segment, which may or may not evolve to ischemia, and are not caused by coronary artery disease, having more recently been related to a coronary vasospasm. This diagnosis becomes especially challenging in patients who have already undergone previous percutaneous coronary procedures. We report a case of a patient diagnosed with Prinzmetal angina with a recent percutaneous coronary intervention due to coronary artery disease.

scholarly journals The Association of Baseline N-terminal Pro-B-type Natriuretic Peptide With Short and Long-term Prognosis Following Percutaneous Coronary Intervention in Non-ST Segment Elevation Acute Coronary Syndrome With Multivessel Coronary Artery Disease: a Retrospective Cohort Study

2020 ◽  
Author(s):  
Wen-fei He ◽  
Lei Jiang ◽  
Yi-yue Chen ◽  
Yuan-hui Liu ◽  
Peng-yuan Chen ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Coronary Intervention ◽  
Multivessel Coronary Artery Disease ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Artery Disease

Abstract Background: Although several studies have shown that N-terminal pro-B-type natriuretic peptide (NT-proBNP) is strongly correlated with coronary artery lesion complexity as well as prognosis in non-ST segment elevation acute coronary syndrome (NSTE-ACS) patients, the prognostic value of NT-proBNP in patients with NSTE-ACS and multivessel coronary artery disease undergoing PCI remains unclear. This study aimed to reveal the relationship between NT-proBNP levels and prognosis among NSTE-ACS patients with multivessel coronary artery disease undergoing successfully percutaneous coronary intervention.Methods: We consecutively enrolled 1022 patients from January 2010 to December 2014. Patients with a diagnosis of NSTE-ACS with multivessel coronary artery disease and NT-proBNP levels were included. The primary outcome was in-hospital all-cause death. The 3-year follow-up all-cause death was also ascertained.Results: A total of 12 (1.2%) deaths occurred during hospitalization. The 4th quartile group of NT-proBNP (>1287 pg/ml) had the highest rate of in-hospital all-cause death (4.3%) (P<0.001). Logistic analyses revealed that increasing NT-proBNP was robustly associated with a higher risk of in-hospital all-cause death (adjusted OR: 2.86, 95% CI=1.16-7.03, P=0.022). NT-proBNP had a good ability to predict in-hospital all-cause death (AUC=0.888, 95% CI=0.834-0.941, P<0.001; cutoff: 1568pg/ml). The cumulative event analyses exhibited a statistically significant relationship between a higher level of NT-proBNP and a higher rate of the long-term all-cause death compared with a lower level of NT-proBNP (P< 0.0001).Conclusions: Increasing NT-proBNP is significant associated with a high risk of in-hospital and long-term all-cause death in NSTE-ACS patients with multivessel coronary artery disease who received percutaneous coronary intervention. NT-proBNP > 1568pg/ml was associated with all-cause, in-hospital death.

scholarly journals Left main percutaneous coronary intervention in acute and chronic coronary disease. A single center experience

2021 ◽  
pp. 1-8
Author(s):  
Cátia Oliveira ◽  
Carlos Braga ◽  
João Costa ◽  
Jorge Marques
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Left Main Coronary Artery ◽  
Coronary Intervention ◽  
Left Main ◽  
St Segment Elevation ◽  
Percutaneous Coronary ◽  
Artery Disease

Background Improvements in percutaneous coronary intervention have reduced complications in the treatment of left main coronary artery disease. The objective of this study was to characterize percutaneous coronary intervention procedures in left main coronary artery, and evaluate patients’ outcomes. Methods A retrospective study performed from January 2015 to December 2018, in patients submitted to percutaneous coronary intervention in left main coronary artery for stable coronary artery disease or myocardial infarction, with second-generation drug-eluting stents. Results A total of 82 patients were submitted to percutaneous coronary intervention in left main coronary artery. Among them, 26.8% had stable coronary artery disease, 50% had non-ST segment elevation myocardial infarction, and 23.2% had ST segment elevation myocardial infarction. Cardiogenic shock was present in 20.7% of them. Most patients were male, elderly, with cardiovascular risk factors, namely diabetes, hypertension and hyperlipemia. Among patients with stable coronary artery disease, patients had low to intermediate SYNTAX score. During hospitalization, patients did not develop any complications. During follow-up, cardiovascular death was of 4.5% (n=1). Regarding non-ST segment elevation myocardial infarction, during hospitalization, there were no registries of events. During follow-up, 9.1% of patients had cardiovascular-related hospitalizations. A patient died (3%) during the re-hospitalization from severe heart failure. Concerning ST segment elevation myocardial infarction patients, there was one case of acute stent thrombosis during hospitalization resulting in death. One patient was readmitted for percutaneous coronary intervention in left main coronary artery due to restenosis. Regarding the patients admitted in cardiogenic shock, in-hospital mortality was 58.8%. During follow-up, two patients experienced restenosis and were hospitalized (one underwent coronary artery bypass grafting, and the other, percutaneous coronary intervention). Conclusion This is a real-world study in which we described our experience with percutaneous coronary intervention in left main coronary artery. In general, percutaneous coronary intervention in left main coronary artery in stable left main coronary artery disease, or in unstable disease with no cardiogenic shock, was a safe procedure. Further studies with extended follow-up are needed.

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