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Patients ≥ 75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome

OBJECTIVE: Absence of significant epicardial coronary artery disease (CAD) in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to analyse the clinical characteristics and outcome of such patients with advanced ag...

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Autores principales: Wong, Vincent, Farah, Ahmed, von Korn, Hubertus, Memisevic, Nedim, Richter, Stefan, Tukhiashvili, Ketevan, Lauer, Bernward, Ohlow, Marc-Alexander
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Science Press 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4308453/
https://www.ncbi.nlm.nih.gov/pubmed/25678899
http://dx.doi.org/10.11909/j.issn.1671-5411.2015.01.002
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author Wong, Vincent
Farah, Ahmed
von Korn, Hubertus
Memisevic, Nedim
Richter, Stefan
Tukhiashvili, Ketevan
Lauer, Bernward
Ohlow, Marc-Alexander
author_facet Wong, Vincent
Farah, Ahmed
von Korn, Hubertus
Memisevic, Nedim
Richter, Stefan
Tukhiashvili, Ketevan
Lauer, Bernward
Ohlow, Marc-Alexander
author_sort Wong, Vincent
collection PubMed
description OBJECTIVE: Absence of significant epicardial coronary artery disease (CAD) in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to analyse the clinical characteristics and outcome of such patients with advanced age. METHODS: We retrospectively analysed 4,311 patients with acute onset of chest pain plus necrosis marker elevation. Two hundred and seventy two patients without CAD on angiogram (6.3%) were identified. Out of them, 50 (1.2%) patients ≥ 75 years (Group I) were compared with (1) 222 acute coronary syndrome (ACS) patients without CAD on angiogram < 75 years (Group II), and (2) 610 consecutive patients ≥ 75 years with Non-ST-elevation Myocardial Infarction (NSTEMI) undergoing percutaneous coronary intervention (Group III). RESULTS: Group I compared to Group III patients made up for more females (64.0% vs. 49.2%; P < 0.0001), and had more severe anginal symptoms on presentation [Canadian Cardiovascular Society (CCS) class I/II, 26.0% vs. 49.8%; P = 0.02]. Group I patients also had lower troponin levels (0.62 ± 0.8 ng/mL vs. 27 ± 74 ng/mL; P < 0.02), lower leukocyte count (9.4 ± 3.13 × 10(9) vs. 12 ± 5.1 × 10(9); P = 0.001) and better preserved left ventricular function (56.7% ± 14.3% vs. 45% ± 11%; P < 0.0001). Event-free survival (cardiac death, myocardial infarction, recurrent angina, and re-hospitalisation) was more frequent in Group I and II patients compared to Group III patients (64.9%, 66.7%, and 41.6%, respectively; P < 0.0001). CONCLUSIONS: ACS in patients ≥ 75 years without CAD is very infrequent, associated with a (1) similar outcome compared to ACS patients < 75 years without CAD, and (2) significant better outcome compared to NSTEMI patients ≥ 75 years.
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spelling pubmed-43084532015-02-12 Patients ≥ 75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome Wong, Vincent Farah, Ahmed von Korn, Hubertus Memisevic, Nedim Richter, Stefan Tukhiashvili, Ketevan Lauer, Bernward Ohlow, Marc-Alexander J Geriatr Cardiol Research Article OBJECTIVE: Absence of significant epicardial coronary artery disease (CAD) in patients with acute onset of chest pain and elevation of myocardial necrosis markers is occasionally observed. The aim of this study was to analyse the clinical characteristics and outcome of such patients with advanced age. METHODS: We retrospectively analysed 4,311 patients with acute onset of chest pain plus necrosis marker elevation. Two hundred and seventy two patients without CAD on angiogram (6.3%) were identified. Out of them, 50 (1.2%) patients ≥ 75 years (Group I) were compared with (1) 222 acute coronary syndrome (ACS) patients without CAD on angiogram < 75 years (Group II), and (2) 610 consecutive patients ≥ 75 years with Non-ST-elevation Myocardial Infarction (NSTEMI) undergoing percutaneous coronary intervention (Group III). RESULTS: Group I compared to Group III patients made up for more females (64.0% vs. 49.2%; P < 0.0001), and had more severe anginal symptoms on presentation [Canadian Cardiovascular Society (CCS) class I/II, 26.0% vs. 49.8%; P = 0.02]. Group I patients also had lower troponin levels (0.62 ± 0.8 ng/mL vs. 27 ± 74 ng/mL; P < 0.02), lower leukocyte count (9.4 ± 3.13 × 10(9) vs. 12 ± 5.1 × 10(9); P = 0.001) and better preserved left ventricular function (56.7% ± 14.3% vs. 45% ± 11%; P < 0.0001). Event-free survival (cardiac death, myocardial infarction, recurrent angina, and re-hospitalisation) was more frequent in Group I and II patients compared to Group III patients (64.9%, 66.7%, and 41.6%, respectively; P < 0.0001). CONCLUSIONS: ACS in patients ≥ 75 years without CAD is very infrequent, associated with a (1) similar outcome compared to ACS patients < 75 years without CAD, and (2) significant better outcome compared to NSTEMI patients ≥ 75 years. Science Press 2015-01 /pmc/articles/PMC4308453/ /pubmed/25678899 http://dx.doi.org/10.11909/j.issn.1671-5411.2015.01.002 Text en Institute of Geriatric Cardiology http://creativecommons.org/licenses/by-nc-sa/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported License, which allows readers to alter, transform, or build upon the article and then distribute the resulting work under the same or similar license to this one. The work must be attributed back to the original author and commercial use is not permitted without specific permission.
spellingShingle Research Article
Wong, Vincent
Farah, Ahmed
von Korn, Hubertus
Memisevic, Nedim
Richter, Stefan
Tukhiashvili, Ketevan
Lauer, Bernward
Ohlow, Marc-Alexander
Patients ≥ 75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome
title Patients ≥ 75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome
title_full Patients ≥ 75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome
title_fullStr Patients ≥ 75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome
title_full_unstemmed Patients ≥ 75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome
title_short Patients ≥ 75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome
title_sort patients ≥ 75 years with acute coronary syndrome but without critical epicardial coronary disease: prevalence, characteristics, and outcome
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4308453/
https://www.ncbi.nlm.nih.gov/pubmed/25678899
http://dx.doi.org/10.11909/j.issn.1671-5411.2015.01.002
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