Faculty Opinions recommendation of Relation of Statin Use and Mortality in Community-Dwelling Frail Older Patients With Coronary Artery Disease.

Abstract Background Cumulative evidence has shown that the non-invasive modality of coronary computed tomography angiography (CCTA) has evolved as an alternative to invasive coronary angiography, which can be used to quantify plaque burden and stenosis and identify vulnerable plaque, assisting in diagnosis, prognosis and treatment. With the increasing elderly population, many patients scheduled for non-cardiovascular surgery may have concomitant coronary artery disease (CAD). The aim of this study was to investigate the usefulness of preoperative CCTA to rule out or detect significant CAD in this cohort of patients and the impact of CCTA results to clinical decision-making. Methods 841 older patients (age 69.5 ± 5.8 years, 74.6% males) with high risk non-cardiovascular surgery including 771 patients with unknown CAD and 70 patients with suspected CAD who underwent preoperative CCTA were retrospectively enrolled. Multivariate logistic regression analysis was performed to determine predictors of significant CAD and the event of cancelling scheduled surgery in patients with significant CAD. Results 677 (80.5%) patients had non-significant CAD and 164 (19.5%) patients had significant CAD. Single-, 2-, and 3- vessel disease was found in 103 (12.2%), 45 (5.4%) and 16 (1.9%) patients, respectively. Multivariate analysis demonstrated that positive ECG analysis and Agatston score were independently associated with significant CAD, and the optimal cutoff of Agatston score was 195.9. The event of cancelling scheduled surgery was increased consistently according to the severity of stenosis and number of obstructive major coronary artery. Multivariate analysis showed that the degree of stenosis was the only independent predictor for cancelling scheduled surgery. In addition, medication using at perioperative period increased consistently according to the severity of stenosis. Conclusions In older patients referred for high risk non-cardiovascular surgery, preoperative CCTA was useful to rule out or detect significant CAD and subsequently influence patient disposal. However, it might be unnecessary for patients with negative ECG and low Agatston score. Trial registration Retrospectively registered.

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FACTORS INFLUENCING HEALTH BEHAVIORS OF KOREAN OLDER ADULTS WITH CORONARY ARTERY DISEASE

Innovation in Aging ◽

10.1093/geroni/igz038.3103 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S843-S843

Author(s):

So Young Shin ◽

Ji Mi Mun

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Health Behaviors ◽

Family Support ◽

Multiple Regression ◽

Older Patients ◽

Well Being ◽

Medication Intake ◽

Factors Influencing ◽

Artery Disease

Abstract Purpose: The purpose of this study was to examine the effects of disease-related knowledge, depression, and family support on health behaviors of older patients with coronary artery disease. Methods: The subjects were 139 older patients with coronary artery disease who had visited the internal medicine outpatient clinic at one general hospital located in metropolitan city B, Korea. A set of self-reported questionnaire was administered to assess general characteristics, disease-related knowledge, depression, family support, and health behaviors of the subjects. Collected data was analyzed using descriptive statistics, t-tests, one-way ANOVA, Pearson correlation coefficients, and multiple regression. Results: The mean (±SD) age of the subjects was 70.86 (±4.70) years. Health behaviors of the subjects had significant negative correlations with disease-related knowledge (r=-.17, p=.050) and depression (r=-.32, p<.001) while having a significant positive correlation with family support (r=.67, p<.001). In the final multiple regression analysis, factors influencing health behaviors of subjects were medication intake status (β=-.17, p=.009), depression (β=-.15, p=.017) and family support (β=.61, p<.001). The explanatory power of the subjects’ medication intake status, disease-related knowledge, depression and family support on health behaviors was 48.9% (F=33.97, p<.001). Conclusion: Medication intake status, depression, and family support had significant influences on health behaviors of older patients with coronary artery disease. Improvements in medication intake, depression, and family support for older patients with coronary artery disease may be beneficial for their health behaviors, and ultimately, have a positive effect on their recovery from the disease and well-being.

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Association of Longitudinal Change in High-Sensitivity Troponin with All-Cause Mortality in Coronary Artery Disease: The Heart and Soul Study

Cardiology ◽

10.1159/000503954 ◽

2020 ◽

Vol 145 (2) ◽

pp. 63-70

Author(s):

Yaanik B. Desai ◽

Rakesh K. Mishra ◽

Qizhi Fang ◽

Mary A. Whooley ◽

Nelson B. Schiller

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

High Sensitivity ◽

Community Dwelling ◽

Longitudinal Change ◽

Clinical Variables ◽

Risk Of Death ◽

Increased Risk ◽

All Cause Mortality ◽

Artery Disease

Background: Serial increases in high-sensitivity cardiac troponin (hs-cTnT) have been associated with death in community-dwelling adults, but the association remains uninvestigated in those with coronary artery disease (CAD). Methods: We measured hs-cTnT at baseline and after 5 years in 635 ambulatory Heart and Soul Study patients with CAD. We also performed echocardiography at rest and after treadmill exercise at baseline and after 5 years. Participants were subsequently followed for the outcome of death. We used a multivariable-adjusted Cox proportional hazards model to evaluate the association between 5-year change in hs-cTnT and subsequent all-cause mortality. Results: Of the 635 subjects, there were 386 participants (61%) who had an increase in hs-cTnT levels between baseline and year 5 measurements (median increase 5.6 pg/mL, IQR 3.2–9.9 pg/mL). There were 182 deaths after a mean 4.2-year follow-up after the year 5 visit. After adjusting for clinical variables, a >50% increase in hs-cTnT between baseline and year 5 was associated with a nearly 2-fold increased risk of death from any cause (hazard ratio 1.7, 95% confidence interval 1.1–2.7). When addition of year 5 hs-cTnT was compared to a model including clinical variables and baseline hs-cTnT, there was a modest but statistically significant increase in C-statistic from 0.82 to 0.83 (p = 0.04). Conclusion: In ambulatory patients with CAD, serial increases in hs-cTnT over time are associated with an increased risk of death.

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