Coronary Syndrome In Elderly Patients Research Articles

Effects of Personalized Nursing plus Dietary Nursing Management on LP-PLA2, Hcy Levels, and Quality of Life in Elderly Patients with Acute Coronary Syndrome.

Objective To explore the effect of individual nursing combined with dietary management on blood glucose levels and quality of life in elderly patients with acute coronary syndrome with diabetes. Method This study included 68 elderly patients who underwent acute coronary syndrome at Department of Emergency in our hospital from January 2018 to January 2020. And they were assigned to a control group (n = 34) treated with individual nursing and a research group (n = 34) treated with individual nursing and dietary management according to the random number table. A comparison of the changes in blood glucose levels, anxiety and depression, quality of life, and nursing satisfaction was made between groups before and after nursing. Result Before nursing, the differences in blood glucose levels, SAS scores, and SDS scores between groups were not considered statistically significant (P > 0.05). After nursing, the blood glucose levels, SAS, and SDS levels of patients in both groups significantly decreased, and the research group presented a higher decrease when compared with the control group (P < 0.05). The short form health survey (SF-36) showed that the research group had higher scores in physical function (PF), general health (GH), vitality (VT), mental health (MH), social function (SF), role-physical (RP), bodily pain (BP), and role-emotional (RE) compared with the control group (P < 0.05). The satisfaction survey presented that the research group had a significantly higher total score than the control group [(91.40 ± 5.23) vs. (86.61 ± 7.14), P < 0.05]. Conclusion The combination of individual nursing and dietary management not only effectively reduces glycosylated hemoglobin levels and anxiety and depression but also wins better nursing satisfaction in the treatment of acute coronary syndrome in elderly patients. Moreover, their quality of life has been significantly improved after discharge.

Outcomes of Very Elderly Patients with ST-Elevation or Non-ST-Elevation Acute Coronary Syndrome: Observational Study

Acute coronary syndromes (ACS) have been classified according to the finding of ST-segment elevation on the presenting electrocardiogram, with different treatment strategies and practice guidelines. However, a comparative description of the clinical characteristics and outcomes of acute coronary syndrome in elderly patients has not been published so far. To compare the baseline characteristics and outcomes of STEMI and NSTEMI patients. Retrospective, observational study of patients hospitalized for ACS between January 2018 and December 2019 in the cardiology department of the university hospital of Sfax. The main outcome measure was the incidence of major adverse cardiovascular events (MACE) including cardiovascular death, reinfarction, and stroke. Of 158 ACS patients aged ≥ 75 years (median age 79.72 years, interquartile range 75-97), 33% were classified as ST-elevation myocardial infarction (STEMI), and 67% had non-ST-elevation myocardial infarction (NSTEMI). As compared with those with NSTEMI, STEMI patients had more favorable baseline risk factors with a lower Charlson comorbidity index (3.48 ± 0.18 versus (vs.) 3,84 ± 0.96, P = 0.031), less kidney failure (19.2% vs. 44%, P = 0.005), less prior coronary events (15.7% vs. 44%, P = 0.006) but more severe coronary disease (double vessel disease and triple vessel disease were respectively (45.7% vs. 22%, P = 0.005) and (37% vs. 15.9%, P = 0.007). At a median follow-up of 12 months, MACE were more frequents in STEMI group (26% vs. 13.5%, P = 0.05). Despite more favorable baseline characteristics, elderly STEMI patients have a higher risk of major cardiovascular events compared with NSTEMI patients.

Socio-Demographic Characteristics and Association of Risk Factors with Type of Acute Coronary Syndrome in Elderly Patients

Socio-Demographic Characteristics and Association of Risk Factors with Type of Acute Coronary Syndrome in Elderly Patients

Non-ST-segment elevation acute coronary syndrome in elderly patients and long-livers. Features of treatment. Literature review and case report

Despite the growing population of elderly people and long-livers every year, the treatment of acute coronary syndrome in these groups is not fully developed and is not regulated in clinical guidelines due to the lack of large randomized clinical trials. The article presents a literature review covering the following issues arising during clinical decision-making in the treatment of non-ST-segment elevation acute coronary syndrome in this group of patients: selection of invasive treatment strategy, scope of myocardial revascularization, appointment of dual antiplatelet therapy taking into account the bleeding risk, decreased renal function and senile asthenia. In addition, a case report of successful treatment of a 101-year-old female patient with non-ST-segment elevation myocardial infarction, who underwent percutaneous coronary intervention with stenting of infarct-related artery, was presented.

Higher Frequency of Undetected Acute Coronary Syndrome in Elderly Patients with Chest Pain Who Visited the Emergency Department: A Large-Cohort Retrospective Study.

Background Acute coronary syndrome (ACS) is a critical disease encountered in the emergency department (ED). Despite the development of diagnostic tools, it may be difficult to diagnose ACS because of atypical symptoms and equivocal test results. We investigated the difference in the rates of revisit and undetected ACS between adult and elderly patients who visited the ED with chest pain. Method Data from 11,323 patients who visited the ED with chest pain at university hospitals in Korea were retrospectively analyzed. The cohort was categorized into two age groups: the adult (30–64 years) and elderly (>65 years). Baseline characteristic data (age, sex, vital signs, triage category, etc.) were obtained. We selected patients who revisited the ED within 30 d and investigated whether ACS was diagnosed. Result The revisit rate was higher in the elderly (12%) than in the adult group (8.3%). The rate of undetected ACS among the revisited patients was 2.91% (18/7,186) in adults and 6.08% (16/1,998) in elderly patients. Conclusion Elderly patients with chest pain had an increased rate of ED revisits and undetected ACS than adult patients. We recommend that old patients should be hospitalized to observe the progression of cardiac complaints or receive short-term follow-up.

Effect of air pollution on the number of hospital admissions for acute coronary syndrome in elderly patients.

Air pollution is a documented risk factor for cardiovascular diseases. The aim of the study was to assess the effect of air pollution on the number of hospital admissions for acute coronary syndrome (ACS) in elderly patients. The medical records of 26 695 patients hospitalized for ACS between 2008 and 2017 were examined. Weather conditions and the following components of air pollution were analyzed: sulfur dioxide, nitrogen dioxide, and particulate matter with a diameter of 2.5 μm or less (PM2.5) and a diameter of 10 μm or less (PM10). The study included 1618 inhabitants of Białystok in Poland (mean [SD] age, 75 [6.4] years; men, 52.6%). The norm for PM2.5 was exceeded on 23.5% of days, while for PM10, on 5.3% of days. Elevated PM10 levels were associated with a higher number of hospitalizations for ACS on the day of exposure (mean [SD], 0.61 [0.78] vs 0.44 [0.69]; P <0.001), and this effect persisted in the subsequent days (mean [SD], 1.07 [1.07] vs 0.88 [1.00]; P = 0.02). An increase of PM10 concentrations by 10 μg/m3 was associated with an increase in the number of hospitalizations due to unstable angina, and significant effects were observed even after 6 days (rate ratio, 1.16; 95% CI, 1.03-1.32; P = 0.02). Increased exposure to air pollution, in particular, elevated PM10 levels, is associated with a higher incidence of ACS both on the day of exposure and over the following days.

In-hospital mortality of acute coronary syndrome in elderly patients.

Objectives:To analyze predictors of death in elderly patients diagnosed with acute coronary syndrome (ACS).Methods:A record-based study carried out between January 2016 and January 2018 at The central province in Saudi Arabia. All elderly patients (>75 years) with definite diagnosis of ACS were retrospectively included. Demographic data, echocardiographic, and angiographic parameters were reported.Results:A total of 179 patients were enrolled, 129 (72%) were male. The mean age was 79±4.7 years. Approximately 102 (57%) patients were diagnosed with ST-segment elevation myocardial infarction (STEMI). Of all 125 (70%) underwent invasive coronary angiography, we found that 43 (24%) had significant single vessel disease (1VD), 29 (16.2%) had 2 vessel disease (2VD), and 41 (22.9%) had 3 vessel disease (3VD) or left main stenosis. During hospitalization 21 (11.7%) patients died, t-test analysis showed patients who died were significantly older (82±6.7 versus [vs.] 79±4.2 years, p=0.003). In addition we found that ejection fraction was lower in death group (30.2%±10.7) vs. (36.5%±1.1) in survivors, p=0.017); STEMI was more common in death group (90.5%) vs. (52.5%) in survivors, p=0.001); similarly, the prevalence of 3VD was higher in death group (38.1%) vs. (20.9%) in survivors, p=0.018). Importantly, PCI was not significantly different between death and survival groups (40% vs. 53.8%, p=0.177). A multivariate regression analysis demonstrated that predictors of death were: age (hazard ratio [HR], 1.214; 95% confidence interval [CI], 1.122-1.384; p<0.0001), intubation (HR, 10.106; 95% CI, 9.844-10.792; p<0.0001), and raised creatinine kinase-MB (CK-MB) (HR, 1.005; 95% CI, 1.002-1.013; p=0.04) predicted in hospital death.Conclusion:Older age, mechanical ventilation and raised CK-MB can significantly predict death in elderly patients (>75-year-old) diagnosed with ACS; nevertheless, PCI showed no survival benefits.

How Does the Presence of Diabetes Affect the Course of Acute Coronary Syndrome in Elderly Patients in Actual Clinical Practice?

The number of elderly patients with diabetes mellitus (DM) is constantly growing in general population. Accordantly, we have the growth of such patients in the group of acute coronary syndrome (ACS).Aim.To compare clinical characteristics of the elderly patient (&gt;75 years old) with and without DM.Material and methods. This retrospective study included 1133 ACS patients who were aged ≥75 years and admitted to the City Clinical Hospital №1 from 01.01.2015 to 31.12.2016. Median age was 80 years, 66% were women. We analyzed 4 patient subgroups: Group 1 – 105 patients with ST-segment elevation myocardial infarction (STEMI) and DM, Group 2 – 254 STEMI patients without DM, Group 3 – 222 non-STEMI patients with DM and Group 4 – 552 non-STEMI patients without DM. We used Student’s t-test and c2 tests to find significant difference between pairs of groups.Results. Median age of patients in 4 groups was 80, 81, 81 and 80 years (p&gt;0.05), age variance was 75-100 years. DM was found in 29% of all elderly patients with no difference between STEMI and non-STEMI groups. STEMI and non-STEMI patients with DM were more likely women. NonSTEMI patients with DM more often had hypertension, previous stroke, lower median Hb (121 vs 127 g/l; p&lt;0.001). Angiography data demonstrated more often three-vessel disease (43% vs 29.7%) and less one-vessel disease (15% vs 25.6%; p&lt;0.05) between groups 3 and 4. Glomerular filtration rate (GFR) &lt;60 ml/min/1.73 m2 occurred in 74%, 73%, 77% and 74% in patients of 4 groups (p&gt;0,05), but GFR&lt;45 ml/min/1.73 m2 was more prevalent in patients with DM than without DM: 45%, 39%, 45%, 36% in 4 groups. Finally, mortality rates didn’t demonstrate significant difference between DM and non-DM patients with STEMI (10% vs 13%; p&gt;0.05) and non-STEMI (7% vs 7%) groups.Conclusion. DM is associated with ACS approximately in one third of the elderly patients and is not associated with its type (STEMI or non-STEMI). In STEMI and non-STEMI patients the female sex and GFR level &lt;45 ml/min/1.73 m2 were associated with DM. In non-STEMI group multi-vessel disease and presence of hypertension and previous stroke were associated with DM. We didn’t find any difference between mortality in elderly patients with and without DM.

Influenza Vaccination is Associated with Lower Risk of Acute Coronary Syndrome in Elderly Patients with Chronic Kidney Disease.

Elderly patients with chronic kidney disease (CKD) are at a higher risk of hospitalization for cardiovascular diseases (CVD). Previous studies have showed that influenza vaccination could reduce the risk of recurrent major cardiovascular events in patients with CVD. However, the effects of influenza vaccination on the reduction of first hospitalizations for acute coronary syndrome (ACS) in elderly patients with CKD remain unknown.We conducted a cohort study using data from the Taiwan Longitudinal Health Insurance Database 1997 to 2008. This cohort study comprised elderly patients (ages ≥55 years) with a recorded diagnosis of CKD (n = 4406) between January 1, 1999, and December 31, 2007. Each patient was followed up until the end of 2008. To minimize the selection bias of vaccine therapy, a propensity score adjustment was applied. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the occurrence of first hospitalization for ACS was evaluated by Cox proportional hazards regression. We further categorized the patients into 4 groups according to their vaccination status (unvaccinated, and total number of vaccinations: 1, 2–3, and ≥4).We found that elderly CKD patients without prior CVD history receiving influenza vaccination exhibited a lower risk of hospitalization for ACS (adjusted HR = 0.35, 95% CI 0.30–0.42; P < 0.001). We observed consistent protective effects regardless of age groups (55–64, 65–74, and ≥75), gender, and seasonality of influenza. When the patients were stratified according to the total number of vaccinations, the adjusted HRs for first ACS hospitalization were 0.62 (95% CI 0.52–0.81), 0.35 (95% CI 0.28–0.45), and 0.13 (95% CI 0.09–0.19) for patients who received 1, 2 to 3, and ≥4 vaccinations. There was a significant trend of decreasing risk of ACS hospitalization with an increasing number of vaccinations.The results of our observational study could strengthen the annual vaccination policy and physicians should be aware of missed opportunities to vaccinate elderly patients with CKD against influenza. The potential public health impact of influenza vaccination, particularly in the elderly CKD patients without a history of CVD, who are at risk for ACS, should be further explored.

Predictive role of high sensitivity troponin T within four hours from presentation of acute coronary syndrome in elderly patients.

BackgroundPrevious studies indicate that the introduction of high-sensitivity troponin T (HsTnT) as a diagnostic tool for chest pain patients in the emergency department (ED) creates a high rate of false-positive tests. In the present study, we aimed to evaluate if the diagnostic performance of HsTnT for acute coronary syndrome (ACS) up to 3–4 h after presentation in elderly patients can be improved.MethodsA total of 477 consecutive patients ≥ 75 years, admitted to in-hospital care for chest pain suspicious of ACS, were retrospectively included. HsTnT values at presentation (0 h) and at 3–4 h were analysed. Receiver operating characteristic (ROC) curves were created for absolute and relative changes from 0 to 3–4 h. ACS, non-elective percutaneous coronary intervention, coronary artery bypass grafting and death of all causes were recorded for all patients during a follow-up of 60 days. Sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were analysed for different HsTnT cut-off values at 0 and 3–4 h and for the combination of a HsTnT at presentation and an absolute change from 0 to 3–4 h.ResultsTwenty-seven percent of the patients had ACS and 21 % acute myocardial infarction (AMI) during the hospital stay. The standard cut-off 14 ng/L gave sensitivity and NPV for ACS of 88 and 90 % at 3–4 h. Specificity and PPV was 38 and 32 % respectively. Analysing for non-ST elevation myocardial infarction (NSTEMI) alone gave a sensitivity and NPV of 100 % but did not improve specificity and PPV. The area under the ROC-curve was larger for absolute than relative HsTnT changes from 0 to 3–4 h. A combination of HsTnT at presentation > 30 ng/L and/or a change > 5 ng/L up to 3–4 h gave a 63 % specificity and a PPV of 46 %, a 99 % sensitivity and a NPV of 99 % for NSTEMI.ConclusionOur study indicates that HsTnT can neither exclude nor confirm ACS within 3–4 h from presentation in patients ≥ 75 years. NSTEMI can be excluded with HsTnT within 3–4 h, but HsTnT cannot be used to rule in NSTEMI during the first 3–4 h, not even by using a combination of the initial HsTnT result and the change from 0 to 3–4 h. With combined criteria, the majority of the positive tests were still false positive. Our results indicate that in patients > 75 years, HsTnT should be used primarily as an early rule-out tool for AMI.

Characteristics of attenuated plaque in culprit lesions for acute coronary syndrome in elderly patients

Objective To explore the characteristics of attenuated plaque (AP) in culprit lesions for acute coronary syndrome (ACS) in elderly patients. Methods This study included 166 ACS patients meeting the conditions from Jan. 1, 2013 to Sep. 31, 2014. Clinical data, vascular lesions determined by coronary angiography and intravenous ultrasound (IVUS)-demonstrated characteristics of culprit plaque, which included presence of AP, maximum attenuation arc, extravascular elastic membrane area, lumen area, plaque area, plaque burden and remodeling index, were recorded. Results Compared with non-elderly group, elderly group had a higher proportion of multiple coronary-artery lesions (50.0% vs. 35.1%, χ2=6.525, P=0.038), more attenuation plaques (62.0% vs. 45.9%, χ2=4.245, P=0.039), a larger maximum attenuation arc〔(142±80)° vs. (115±54)°, t=5.254, P=0.000〕, larger plaque area〔(14.2±3.9)mm2vs. (12.3±4.1)mm2,t=2.325, P=0.022〕, more plaque burden 〔(81.1±14.2)% vs. (76.4±13.5)%, t=2.025, P=0.042〕 and higher remodeling index 〔(1.19±0.17) vs. (1.09±0.13), t=4.245, P=0.031〕. Conclusions The onset of ACS is more closely related with the unstable plaque in elderly patients, and strengthening the measures for plaque stabilization will be helpful in the prevention and treatment of ACS in the elderly. Key words: Acute coronary syndrome; Coronary angiography; Ultrasonography; Attenuated plaque

0052: Quality of life and complication after acute coronary syndrome in elderly patients

Acute coronary syndrome in the elderly patients is a particular clinical entity characterized by increased incidence. Medical advances and improvement of the conditions of life acquires of the elderly person the progression of their autonomy. Our aim is to evaluate the quality of life of elderly patients after ACS treated by angioplasty. We had collected 141 elderly patients (>75 ans) (mean age:80.6± 4.03 years old) admitted for NSTEMI in Haguenau hospital center in France, between august 2012 and august 2013. 58.2% had percutaneous coronary intervention (PCI), 34% medical treatment and 7.8% CABG. In the acute phase after PCI: renal failure 11%(vs 6.3% after medical treatment), heart failure 7.3% (vs 6.3%), recurrence infarction 6.1% (vs: 0%). Mortality of 2.4% (vs: 0%). At 6 month after PCI: renal failure 3.8% (vs: 0%), recurrent infarction 7.5% (vs 4,2%) and heart failure 6.3%(vs 8,3%). Mortality of 1.4%(vs: 0%). The quality of life has improved in 45% after PCI, versus 12,5% after medical treatment. At 1 year after PCI: mortality 1,3% and recurrent infarction1. 3%. The quality of life has improved in 53.2% versus 12.5% after medical treatment. While a stationary quality of life is noted in 72.9% after medical treatment. Angioplasty in elderly patients improves the quality of life, especially of physical health, but with some cases of complications. While medical treatment that maintained a steady state of quality of life with fewer complications.

Influenza vaccination reduces hospitalization for acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease: A population-based cohort study

BackgroundElderly patients with chronic obstructive pulmonary disease (COPD) are at a higher risk of hospitalization for cardiovascular complications, especially during respiratory infections. Previous studies showed that vaccination for influenza may reduce the risk of recurrent major cardiovascular events in patients with acute coronary syndrome (ACS). The purpose of this study was to evaluate the hypothesis that influenza vaccination could reduce hospitalizations for ACS in elderly patients with COPD. MethodUsing the Taiwan Longitudinal Health Insurance Database 1996–2008, this cohort study comprised elderly patients (≥55 years old) with a recorded diagnosis of COPD (n=7722) between January 1, 2000 and December 31, 2007. Each patient was followed until the end of 2007. A propensity score was derived by using a logistic regression model to reduce vaccine therapy selection bias. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the occurrence of first hospitalization for ACS in elderly COPD patients was examined by Cox proportional hazards regression analysis. In addition, we categorized the patients into four groups according to vaccination status (unvaccinated, total number of vaccinations: 1, 2−3, and ≥4). ResultsWe found that elderly patients with COPD receiving influenza vaccination had a lower risk of hospitalization for ACS (adjusted HR=0.46, 95% CI (0.39–0.55), p<0.001). We observed similar protective effects in both sexes and all age groups (55−64, 65−74, ≥75) regardless of influenza seasonality. When the patients were stratified according to the total number of vaccinations, the adjusted HRs for hospitalization because of ACS were 0.48 (0.38−0.62) and 0.20 (0.14−0.28) for patients who received 2−3 and ≥4 vaccinations during the follow-up period. ConclusionOur data showed that there was a lower risk of ACS hospitalization in elderly patients with COPD receiving annual influenza vaccination.

An underdiagnosed cause of CK-MB elevation in absence of acute coronary syndrome in elderly patients

An underdiagnosed cause of CK-MB elevation in absence of acute coronary syndrome in elderly patients

Review of the treatment of acute coronary syndrome in elderly patients

Advances in treatment and early revascularization have led to improved outcomes for patients with acute coronary syndrome (ACS). However, elderly ACS patients are less likely to receive evidence-based treatment, including revascularization therapy, due to uncertainty of the associated benefits and risks in this population. This article addresses key issues regarding medical and revascularization therapy in elderly ACS patients based on a review of the medical literature and in concordance with clinical practice guidelines from the American Heart Association (AHA) and the American College of Cardiology (ACC).