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Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS

BACKGROUND: Whether very elderly women with acute coronary syndromes (ACS) should receive aggressive percutaneous coronary intervention (PCI) is still controversial. We assessed the effectiveness and long-term clinical outcomes of successful PCI in this population and identified prognostic factors w...

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Autores principales: Wang, Jia-li, Guo, Chun-yan, Chen, Hui, Li, Hong-wei, Zhao, Xue-qiao, Zhao, Shu-mei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934370/
https://www.ncbi.nlm.nih.gov/pubmed/33663377
http://dx.doi.org/10.1186/s12872-021-01933-7
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author Wang, Jia-li
Guo, Chun-yan
Chen, Hui
Li, Hong-wei
Zhao, Xue-qiao
Zhao, Shu-mei
author_facet Wang, Jia-li
Guo, Chun-yan
Chen, Hui
Li, Hong-wei
Zhao, Xue-qiao
Zhao, Shu-mei
author_sort Wang, Jia-li
collection PubMed
description BACKGROUND: Whether very elderly women with acute coronary syndromes (ACS) should receive aggressive percutaneous coronary intervention (PCI) is still controversial. We assessed the effectiveness and long-term clinical outcomes of successful PCI in this population and identified prognostic factors which might contribute to the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the very elderly female PCI cohort. METHODS: Female ACS patients aged ≥ 80 years were consecutively enrolled (n = 729) into the study. All the patients were divided into female PCI group (n = 232) and medical group (n = 497). MACCE was followed up, including non-fatal myocardial infarction (MI), stroke, heart failure requiring hospitalization (HFRH), cardiovascular (CV) death, and the composite of them. After propensity score matching (1:1), the incidences of MACCE were compared between the two groups. Clinical and coronary artery lesion characteristics were compared between the female PCI patients with (n = 56) and without MACCE (n = 176). Multivariate Cox regression analysis was performed to identify risk factors which independently associated with MACCE in the female PCI patients. MACCE of male PCI patients, who aged ≥ 80 years and hospitalized in the same period (n = 264), was also compared with that of the female PCI patients. RESULTS: A total of 32% very elderly female ACS patients received PCI in the present study. (1) Compared to female medical group, PCI procedure significantly alleviated the risks of MACCE: non-fatal MI (6.2% vs. 20.2%, P < 0.001), HFRH (10.9% vs. 22.5%, P = 0.012), CV death (12.4% vs. 28.7%, P < 0.001) and the composite MACCE (24.0% vs. 44.2%, P < 0.001) during the median follow-up period of 36 months. (2) Between very elderly female and male PCI patients, there were no significant differences in occurrence of MACCE (P = 0.232) and CV death (P = 0.951). (3) Multivariate Cox analysis revealed that ST-segment elevation myocardial infarction (STEMI) (HR 1.944, 95% CI 1.11–3.403, P = 0.02) and elevated log- N-Terminal pro-brain natriuretic peptide (NT-proBNP) (HR 1.689, 95% CI 1.029–2.773, P = 0.038) were independently associated with the incidence of MACCE in the female PCI patients. CONCLUSIONS: PCI procedure significantly attenuated the risk of MACCE and improved the long-term clinical outcomes in very elderly female ACS patients. Aggressive PCI strategy may be reasonable in this population.
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spelling pubmed-79343702021-03-08 Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS Wang, Jia-li Guo, Chun-yan Chen, Hui Li, Hong-wei Zhao, Xue-qiao Zhao, Shu-mei BMC Cardiovasc Disord Research Article BACKGROUND: Whether very elderly women with acute coronary syndromes (ACS) should receive aggressive percutaneous coronary intervention (PCI) is still controversial. We assessed the effectiveness and long-term clinical outcomes of successful PCI in this population and identified prognostic factors which might contribute to the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the very elderly female PCI cohort. METHODS: Female ACS patients aged ≥ 80 years were consecutively enrolled (n = 729) into the study. All the patients were divided into female PCI group (n = 232) and medical group (n = 497). MACCE was followed up, including non-fatal myocardial infarction (MI), stroke, heart failure requiring hospitalization (HFRH), cardiovascular (CV) death, and the composite of them. After propensity score matching (1:1), the incidences of MACCE were compared between the two groups. Clinical and coronary artery lesion characteristics were compared between the female PCI patients with (n = 56) and without MACCE (n = 176). Multivariate Cox regression analysis was performed to identify risk factors which independently associated with MACCE in the female PCI patients. MACCE of male PCI patients, who aged ≥ 80 years and hospitalized in the same period (n = 264), was also compared with that of the female PCI patients. RESULTS: A total of 32% very elderly female ACS patients received PCI in the present study. (1) Compared to female medical group, PCI procedure significantly alleviated the risks of MACCE: non-fatal MI (6.2% vs. 20.2%, P < 0.001), HFRH (10.9% vs. 22.5%, P = 0.012), CV death (12.4% vs. 28.7%, P < 0.001) and the composite MACCE (24.0% vs. 44.2%, P < 0.001) during the median follow-up period of 36 months. (2) Between very elderly female and male PCI patients, there were no significant differences in occurrence of MACCE (P = 0.232) and CV death (P = 0.951). (3) Multivariate Cox analysis revealed that ST-segment elevation myocardial infarction (STEMI) (HR 1.944, 95% CI 1.11–3.403, P = 0.02) and elevated log- N-Terminal pro-brain natriuretic peptide (NT-proBNP) (HR 1.689, 95% CI 1.029–2.773, P = 0.038) were independently associated with the incidence of MACCE in the female PCI patients. CONCLUSIONS: PCI procedure significantly attenuated the risk of MACCE and improved the long-term clinical outcomes in very elderly female ACS patients. Aggressive PCI strategy may be reasonable in this population. BioMed Central 2021-03-04 /pmc/articles/PMC7934370/ /pubmed/33663377 http://dx.doi.org/10.1186/s12872-021-01933-7 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Wang, Jia-li
Guo, Chun-yan
Chen, Hui
Li, Hong-wei
Zhao, Xue-qiao
Zhao, Shu-mei
Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS
title Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS
title_full Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS
title_fullStr Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS
title_full_unstemmed Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS
title_short Improvement of long-term clinical outcomes by successful PCI in the very elderly women with ACS
title_sort improvement of long-term clinical outcomes by successful pci in the very elderly women with acs
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7934370/
https://www.ncbi.nlm.nih.gov/pubmed/33663377
http://dx.doi.org/10.1186/s12872-021-01933-7
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