2018 Vol. 15, No. 12
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2018, 15(12): 713-717.
doi: 10.11909/j.issn.1671-5411.2018.12.003
Abstract:
Background Elderly patients with acute coronary syndromes (ACS) are at higher risk both for ischemic and bleeding complications. Current guidelines recommend the PRECISE-DAPT score for bleeding risk stratification in this setting, but no study assessed its applicability in elderly patients. This study aimed to assess the performance of the PRECISE-DAPT score in a series of non-selected elderly patients with ACS from routine clinical practice. Methods The IFFANIAM registry included prospectively patients aged ≥ 75 years with ST segment elevation myocardial infarction (STEMI). Main outcome measured was the incidence of relevant bleeding after discharge (bleeding leading to hospital readmission, need for transfusion, intervention, stop of antithrombotic drugs or death). Bleeding risk was classified: (A) according to PRECISE-DAPT values above or not the recommended cut-off point (≥ 25); and (B) according to the quartiles of PRECISE-DAPT values observed in the IFFANIAM series (Q1: Results A total of 208 patients were included. Mean age was 81.9 ± 4.5 years. Most patients (92.6%) had a PRECISE-DAPT value > 25. A total of 25 patients (12.0%) had bleeding events and 49 patients (23.6%) died. No significant differences regarding the incidence of bleeding were observed according to the recommended cutt of point ≥ 25. However, a progressive increase in the incidence of bleeding was observed across PRECISE-DAPT quartiles observed in this series (P = 0.038). Conclusions The vast majority of elderly patients have PRECISE-DAPT values above the recommended cut-off point for bleeding risk. Using different cut-off points could be a more rational approach for predicting bleeding risk in these complex patients.
Background Elderly patients with acute coronary syndromes (ACS) are at higher risk both for ischemic and bleeding complications. Current guidelines recommend the PRECISE-DAPT score for bleeding risk stratification in this setting, but no study assessed its applicability in elderly patients. This study aimed to assess the performance of the PRECISE-DAPT score in a series of non-selected elderly patients with ACS from routine clinical practice. Methods The IFFANIAM registry included prospectively patients aged ≥ 75 years with ST segment elevation myocardial infarction (STEMI). Main outcome measured was the incidence of relevant bleeding after discharge (bleeding leading to hospital readmission, need for transfusion, intervention, stop of antithrombotic drugs or death). Bleeding risk was classified: (A) according to PRECISE-DAPT values above or not the recommended cut-off point (≥ 25); and (B) according to the quartiles of PRECISE-DAPT values observed in the IFFANIAM series (Q1: Results A total of 208 patients were included. Mean age was 81.9 ± 4.5 years. Most patients (92.6%) had a PRECISE-DAPT value > 25. A total of 25 patients (12.0%) had bleeding events and 49 patients (23.6%) died. No significant differences regarding the incidence of bleeding were observed according to the recommended cutt of point ≥ 25. However, a progressive increase in the incidence of bleeding was observed across PRECISE-DAPT quartiles observed in this series (P = 0.038). Conclusions The vast majority of elderly patients have PRECISE-DAPT values above the recommended cut-off point for bleeding risk. Using different cut-off points could be a more rational approach for predicting bleeding risk in these complex patients.
2018, 15(12): 718-724.
doi: 10.11909/j.issn.1671-5411.2018.12.006
Abstract:
Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients. Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure (ICD-10-TM code: 150.9) during 2008?2012 according to three major Thailand reimbursement systems (civil servant, social security, and universal coverage systems). Patients were categorized into either the elderly group (age > 65 years) or the non-elderly group (age ≤ 65 years). Mortality rate and survival analysis were compared between groups. Demographic, underlying disease and comorbid condition data were collected. Cardiovascular and non-cardiovascular death was also analyzed. Results A total of 201,709 patients were included. The average age of patients was 64.9 ± 14.8 years, and the gender proportion breakdown was 84,155 (41.7%) males and 117,554 (58.3%) females. Just over half of patients (107,325 patients; 53.2%) were elderly. Overall mortality rate was 50.8%. The mortality rate at one month, six months, one year, and three years was 11.0%, 24.5%, 32.5%, and 46.3%, respectively. Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio (OR) of 1.47 (95% CI: 1.46-1.49) for all-cause mortality, an OR of 1.25 (95% CI: 1.23-1.27) for cardiovascular death, and an OR of 1.72 (95% CI: 1.68-1.75) for non-cardiovascular death (all P Conclusions The overall mortality rate after heart failure hospitalization was a very high 50.8%. Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization. This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.
Objective To investigate heart failure mortality compared between elderly and non-elderly Thai patients. Methods This study included patients at least 18 years of age who were admitted to the hospital with a primary diagnosis of heart failure (ICD-10-TM code: 150.9) during 2008?2012 according to three major Thailand reimbursement systems (civil servant, social security, and universal coverage systems). Patients were categorized into either the elderly group (age > 65 years) or the non-elderly group (age ≤ 65 years). Mortality rate and survival analysis were compared between groups. Demographic, underlying disease and comorbid condition data were collected. Cardiovascular and non-cardiovascular death was also analyzed. Results A total of 201,709 patients were included. The average age of patients was 64.9 ± 14.8 years, and the gender proportion breakdown was 84,155 (41.7%) males and 117,554 (58.3%) females. Just over half of patients (107,325 patients; 53.2%) were elderly. Overall mortality rate was 50.8%. The mortality rate at one month, six months, one year, and three years was 11.0%, 24.5%, 32.5%, and 46.3%, respectively. Elderly patients had a higher rate of mortality compared to non-elderly patients with an adjusted odds ratio (OR) of 1.47 (95% CI: 1.46-1.49) for all-cause mortality, an OR of 1.25 (95% CI: 1.23-1.27) for cardiovascular death, and an OR of 1.72 (95% CI: 1.68-1.75) for non-cardiovascular death (all P Conclusions The overall mortality rate after heart failure hospitalization was a very high 50.8%. Multivariate analysis revealed elderly status to be an independent predictor of mortality after hospitalization. This finding suggests that improvements are needed related to the quality of care and follow-up given to elderly Thai heart failure patients.
2018, 15(12): 725-731.
doi: 10.11909/j.issn.1671-5411.2018.12.008
Abstract:
Background Recent studies have demonstrated that cystatin C is a valuable risk marker for cardiovascular disease morbidity and mortality. Therefore, we hypothesized that the pre-ablation cystatin C level was associated with post-ablation atrial fibrillation (AF) recurrence. Methods 207 patients were enrolled and completed in this prospective observational study. Patients with AF scheduled for receive radiofrequency catheter ablation (RFCA) therapy were screened for the study. Before ablation therapy, electrocardiogram, 24 h holter monitor, transesophageal echocardiography, serum cystatin C, high-sensitivity C-reactive protein, creatinine levels, and routine blood examinations were examined. After ablation, patients were followed up every week for the first month, and then at 2, 3, 6, 9, and 12 months. Thereafter, patients came back to out-patient clinic every six months regularly. Electrocardiogram or 24 h holter monitor were repeated if the patient experienced palpitations or every six months. AF recurrence was defined as atrial fibrillation/atrial flutter or atrial tachycardia lasting ? 30 seconds within three months after therapy. Results Compared to patients with no AF recurrence, patients with recurrence had longer AF history (P = 0.007), more early recurrence (P = 0.000), a larger left atrium (P = 0.004), and higher pre-ablation cystatin C levels (P = 0.000). Multivariate regression analysis revealed that cystatin C and left atria (LA) diameter were risk factors for AF recurrence. After adjusting for LA diameter, the risk of AF recurrence increased 30% with every milligram cystatin C elevation (95% CI: 1.117-1.523). Conclusions Pre-ablation cystatin C levels were associated with AF recurrence after RFCA therapy, an optimal cut-off value of 1.190 mg/L (sensitivity = 0.576; specificity = 0.851).
Background Recent studies have demonstrated that cystatin C is a valuable risk marker for cardiovascular disease morbidity and mortality. Therefore, we hypothesized that the pre-ablation cystatin C level was associated with post-ablation atrial fibrillation (AF) recurrence. Methods 207 patients were enrolled and completed in this prospective observational study. Patients with AF scheduled for receive radiofrequency catheter ablation (RFCA) therapy were screened for the study. Before ablation therapy, electrocardiogram, 24 h holter monitor, transesophageal echocardiography, serum cystatin C, high-sensitivity C-reactive protein, creatinine levels, and routine blood examinations were examined. After ablation, patients were followed up every week for the first month, and then at 2, 3, 6, 9, and 12 months. Thereafter, patients came back to out-patient clinic every six months regularly. Electrocardiogram or 24 h holter monitor were repeated if the patient experienced palpitations or every six months. AF recurrence was defined as atrial fibrillation/atrial flutter or atrial tachycardia lasting ? 30 seconds within three months after therapy. Results Compared to patients with no AF recurrence, patients with recurrence had longer AF history (P = 0.007), more early recurrence (P = 0.000), a larger left atrium (P = 0.004), and higher pre-ablation cystatin C levels (P = 0.000). Multivariate regression analysis revealed that cystatin C and left atria (LA) diameter were risk factors for AF recurrence. After adjusting for LA diameter, the risk of AF recurrence increased 30% with every milligram cystatin C elevation (95% CI: 1.117-1.523). Conclusions Pre-ablation cystatin C levels were associated with AF recurrence after RFCA therapy, an optimal cut-off value of 1.190 mg/L (sensitivity = 0.576; specificity = 0.851).
2018, 15(12): 732-737.
doi: 10.11909/j.issn.1671-5411.2018.12.001
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2018, 15(12): 738-743.
doi: 10.11909/j.issn.1671-5411.2018.12.005
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2018, 15(12): 744-746.
doi: 10.11909/j.issn.1671-5411.2018.12.007
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2018, 15(12): 747-750.
doi: 10.11909/j.issn.1671-5411.2018.12.002
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2018, 15(12): 751-754.
doi: 10.11909/j.issn.1671-5411.2018.12.004
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