One-year Outcome after Percutaneous Coronary Intervention in Nonagenarians: Insights from the J-PCI OUTCOME Registry.

Objective Chronic kidney disease (CKD) is a clinical collective term for kidney disease with glomerular filtration rate (GFR) < 60 mL/min for more than three months due to various factors and is usually associated with coronary heart disease and is also an independent risk factor for coronary heart disease. This study is aimed at systematically reviewing the influence of CKD on the outcomes of patients after percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs). Methods The Cochrane Library, PubMed, Embase, China biomedical literature database (SinoMed), China National Knowledge Infrastructure, and Wanfang database were searched for case-control studies on the influence of CKD on outcomes after PCI for CTOs. After screening the literature, extracting data, and evaluating the quality of literature, RevMan 5.3 software was used for meta-analysis. Results There were 11 articles with a total of 558,440 patients included. Meta-analysis results indicated that left ventricular ejection fraction (LVEF) level, diabetes, smoking, hypertension, coronary artery bypass grafting, angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), β-blockers, age, and renal insufficiency were the factors affecting outcomes after PCI for CTOs [risk ratio and 95% confidence interval were: 0.88 (0.86, 0.90), 0.96 (0.95, 0.96), 0.76 (0.59, 0.98), 1.39 (0.89, 2.16), 0.73 (0.38, 1.40), 0.24 (0.02, 3.9), 0.78 (0.77, 0.79), 0.81 (0.80, 0.82), and 1.50 (0.47, 4.79)]. Conclusion LVEF level, diabetes, smoking, hypertension, coronary artery bypass grafting, ACEI/ARB, β-blockers, age, renal insufficiency, etc. are important risk factors for outcomes after PCI for CTOs. Controlling these risk factors is of great significance for the prevention, treatment, and prognosis of CKD.

/pdf/a-systematic-review-and-meta-analysis-of-influences-of-21zwh22y.pdf

A Systematic Review and Meta-Analysis of Influences of Chronic Kidney Disease on Patients after Percutaneous Coronary Intervention for Chronic Total Occlusions

A síndrome coronariana aguda (SCA) é um conjunto de alterações miocárdicas desencadeadas pela irrigação sanguínea deficiente nas artérias coronárias, é considerado um grande problema de saúde pública mundial. Está diretamente relacionada com fatores de risco modificáveis como tabagismo, dislipidemia, obesidade, hipertensão arterial, e sedentarismo. O objetivo do estudo foi propiciar um maior conhecimento dos pacientes e profissionais da saúde acerca dos fatores desencadeantes da SCA em adultos e a importância de preveni-los. Diante disso, elaborou-se um estudo de caráter descritivo e exploratório com intuito de buscar na prática dados que corroboram com a revisão bibliográfica.  A metodologia empregada foi uma ação educativa voltada para pacientes e profissionais da saúde de uma Unidade Básica de Saúde (UBS) de um Município do Meio Oeste Catarinense, finalizada com distribuição de folder contendo informações importantes sobre epidemiologia, definição, prevenção, principais sintomas e condutas frente à SCA. Por fim, concluímos que a maioria das pessoas abordadas não tinham conhecimento adequado sobre a SCA, ignorando a importância deste tema. Observou-se ainda que essas pessoas não praticavam atividade física e não tinham uma alimentação adequada.

/pdf/sindrome-coronariana-aguda-e-sua-prevencao-uma-revisao-1v0hpmc4.pdf

Síndrome coronariana aguda e sua prevenção: uma revisão bibliográfica

Recent studies have examined the results of treatment of nonagenarians with percutaneous coronary intervention (PCI) and found promising survival benefits for patients treated with PCI. Despite these benefits, there continue to be large variations in patient selected for PCI based on such factors as frailty, gender, chronic disease, and age. These factors and other patient presentations form the basis for wide variation in treatment and underscore that future studies may increase understanding of patient selection and predict nonagenarians who benefit most from treatment

/pdf/variations-in-the-treatment-of-coronary-syndromes-in-2g2uh0pw.pdf

Variations in the Treatment of Coronary Syndromes in Nonagenarians

Background Primary percutaneous coronary intervention (PCI) is the preferred treatment strategy for patients with ST-elevation myocardial infarction (STEMI); however, its efficacy remains unclear in very older adult patients with STEMI. Methods This retrospective single-center observational study included 530 patients aged >75 years admitted to Tel Aviv Sourasky Medical Center with a diagnosis of acute STEMI. Primary PCI was performed for patients with symptoms ≤12 hours in duration, while the other patients were conservatively treated. We evaluated 30-day mortality and complications occurring during hospitalization based on data from patient records. Results Among the study patients, only 28/530 (5%) were conservatively treated. In-hospital complications, including the use of inotropes or intra-aortic balloon counterpulsation and the need for mechanical ventilation, did not differ significantly between the groups. The only parameter that showed a trend toward significance was the incidence of heart failure during hospitalization (p=0.042). The risk for 30-day mortality was substantially higher in the conservative treatment group than in the invasive treatment group (27% vs. 10%; p = 0.02). Conclusion Our data suggested that despite concerns regarding the safety of the primary PCI strategy in the older adult STEMI population, this treatment strategy was associated with a survival benefit.

/pdf/invasive-versus-conservative-treatment-approach-among-older-24zpbi99.pdf

Invasive versus Conservative Treatment Approach among Older Adult Patients Admitted with Acute ST-Segment Elevation Myocardial Infarction

Previous studies have demonstrated the feasibility of primary percutaneous coronary intervention (PPCI) in carefully selected nonagenarians. Although current guidelines recommend immediate revascularization in patients with ST elevation myocardial infarction (STEMI) it remains unclear whether PPCI reduces mortality in nonagenarians. The objective of this study is to compare mortality in nonagenarians presenting via the PPCI pathway who undergo coronary intervention, versus those who are managed medically. A total of 111 consecutive nonagenarians who presented to our tertiary center via the PPCI pathway between July 2013 and December 2018 with myocardial infarction were included. Clinical and angiographic details were collected alongside data on all-cause mortality. The final diagnosis was STEMI in 98 (88.3%) and NSTEMI in 13 (11.7%). PPCI was performed in 42 (37.8%), while 69 (62.2%) were medically managed. A significant number of the medically managed cohort had atrial fibrillation (23.2% vs 2.4% p = 0.003) and presented with a completed infarct (43.5% vs 4.8% p = 0.001). Other baseline and clinical variables were well matched in both groups. There was a trend towards increased 30-day mortality in the medically managed group (40.6% vs 23.8% p = 0.07). Kaplan Meier survival analysis demonstrated a significant difference in survival by 3 years (48.1% vs 21.7% p = 0.01). This was the case even when those with completed infarcts were excluded (44.3% vs 14.6%, p = 0.01).
 In this series of selected nonagenarians presenting with acute myocardial infarction, those undergoing PPCI appeared to have a lower mortality compared to those managed medically.

/pdf/primary-percutaneous-coronary-intervention-in-nonagenarians-xp7asg10u0.pdf

Primary percutaneous coronary intervention in nonagenarians: is it worthwhile?

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Primary percutaneous coronary intervention in nonagenarians: is it worthwhile?