[Risk factors for adverse outcomes after percutaneous coronary intervention in patients aged over 75 years with non-ST-segment elevation acute coronary syndrome.]
Aug 2026· Advances in gerontology = Uspekhi gerontologii· Vol 39 3, pp.
413-420
· 0 citations· 11 references
Medicine
TL;DR
Among patients over 75 years of age, the PCI group had a higher incidence of adverse events, total complications, and mortality compared to the conservative management group, and the strongest predictors of mortality in this group were patient age, elevated CPK-MB levels at admission, and total complications.
Abstract
Myocardial infarction is a life-threatening condition with high mortality, which is especially important for patients over 75 years of age who have an increased risk of complications and death. Objective - to assess the incidence of in-hospital mortality and adverse cardiovascular events in patients aged over 75 years with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who underwent percutaneous coronary intervention. An analysis of data from a prospective registry of patients with ACS hospitalized in the vascular center based on the Alexandrovskaya City Hospital from January 2016 to November 2024 was performed. The initial sample included 14 420 cases of hospitalization, including 10 126 patients with NSTE-ACS. For the analysis, patients were stratified into four groups: 1st - up to 60 years old; 2nd - 60-74 years old; 3rd - 75-89 years old; 4th - 90 years and older. Data processing was performed using Excel, Jamovi, IBM SPSS Statistic 24, R statistical programs. Values of p<0,05 were considered statistically significant. Coronary angiography was performed in 98,6 % of patients. With increasing age, the following are noted: an increase in the proportion of women, an increase in the number of comorbidities, the Charlson comorbidity index, the number of points on the Killip, CRUSADE, GRACE scales, an increase in the number of complications and fatal outcomes. Among patients over 75 years of age, the PCI group had a higher incidence of adverse events, total complications, and mortality compared to the conservative management group. The strongest predictors of mortality in this group were patient age, elevated CPK-MB levels at admission, and total complications. Predictors of the composite endpoint were elevated CPK-MB levels, AIM Score, and systolic blood pressure at admission. Elderly patients and long-term survivors with MI represent a high-risk group, necessitating an individualized and balanced approach at all stages of treatment. Further research is needed to determine optimal treatment strategies for non-ST-elevation ACS in older age groups.
Aim
. To study 5-year outcomes in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in a prospective registry.
Material and methods
. The Registry of Acute Coronary Syndrome without ST-segment Elevation in the Regional Vascular Center (CONTRAST) included 136 patients admitted to the Sergiyev Posad Vascular Center from October 2018 to March 2019 with a diagnosis of NSTE-ACS. At discharge, the patients were diagnosed with unstable angina (UA) (n=112) or non-ST-segment elevation MI (NSTEMI) (n=24). Five-year outcomes were analyzed.
Results
. The primary composite endpoint (CEP), including all-cause death, nonfatal myocardial infarction (MI), cerebrovascular accident, and emergency hospitalizations for cardiovascular causes, was recorded in 60 patients. Patients with CEP did not differ in age, sex, or risk factors compared to patients without CEP, but they were more likely to have a history of MI, hypokinesis on echocardiography, and a mildly reduced left ventricular ejection fraction. There were no significant differences in the incidence of CEP between patients with NSTEMI and UA. Multivariate Cox regression analysis showed that independent CEP predictors included hypokinesia area on echocardiography, a moderately reduced left ventricular ejection fraction, pleural effusion in the acute phase, and atrial fibrillation. Patients with NSTEMI and UA did not differ in the likelihood of CEP. PCI during and after the reference hospitalization also did not affect the likelihood of CEP.
Conclusion
. In a 5-year prospective follow-up study of patients with NSTE-ACS, the likelihood of adverse outcomes was determined primarily by clinical and imaging risk factors identified in the acute phase and was independent of the formal discharge diagnosis (UA or NSTEMI).
E. P. Kalajdzhyan, A. Zagrebelny, N. Kutishenko et al.· CARDIOVASCULAR THERAPY AND P...· 0 citations
A single-center, retrospective study included 41 patients over 90 years of age who underwent primary percutaneous coronary intervention for the treatment of acute coronary syndrome in the period from 01.2019 to 01.2023. Based on electrocardiography data, patients were divided into 2 groups: Group 1 (n=21) with ST-segment elevation acute coronary syndrome (ST-ACS), Group 2 (n=20) with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Multivessel coronary artery disease was detected in 71% of cases in STE-ACS versus 65% of cases in the NSTE-ACS group (p=0,658). Moreover, simultaneous complete revascularization was predominantly performed in NSTE-ACS (p=0,043). The length of stay in the intensive care unit was comparable (p=0,575), as was the overall length of hospital stay (p=0,463). In-hospital mortality was 35% for NSTE-ACS and 38,1% for STE-ACS (p=0,837). The incidence of hospital-acquired pneumonia, stroke, and bleeding did not differ significantly between the comparison groups. According to the data obtained, patients over 90 years of age with acute coronary syndrome with and without ST-segment elevation can successfully and safely undergo percutaneous coronary intervention.
T. R. Vildanov, N. Lukyanov, K. Kozlov et al.· Advances in gerontology = Us...· 0 citations
The occurrence of NOAF was associated with increased in-hospital mortality, which was 2–3 times higher in patients with arrhythmia, and most NOAF prediction models developed specifically in STEMI cohorts undergoing PCI demonstrated higher discriminative ability.
R. L. Pak, B. I. Geltser, E. Kokarev et al.· Siberian Journal of Clinical...· 0 citations
To identify risk factors and predictors of hospital complications of myocardial infarction in young patients.
Materials and Methods
. The prospective study included 130 young patients aged 18 to 44 years with ST-segment elevation myocardial infarction who underwent endovascular revascularization. The average age was 38.9 ± 5.4 years. All patients included in the prospective study underwent conventional clinical, instrumental, and laboratory examinations, which included the collection of anamnestic data, physical examinations, and a set of laboratory tests, including high-sensitivity troponin I (TnI), complete blood count, biochemical blood test, and N-terminal fragment of brain natriuretic peptide (NT-pro-BNP). Patients underwent echocardiography and coronary angiography. Contrast-enhanced cardiac magnetic resonance imaging was performed 3–5 days after the endovascular intervention.
Results
. Factors associated with the development of life-threatening complications at the hospital stage of treatment in young patients with MI were: pre-revascularization TIMI flow grade 0–1; thrombosis of the proximal segment of the left anterior descending artery; absence of collateral circulation and intermediate coronary stenoses, time to reperfusion, Killip class III–IV heart failure.
Risk factors and predictors of hospital heart failure development in young patients were: the time interval from the onset of pain syndrome to reperfusion; the presence of microvascular obstruction and intramyocardial hemorrhage on MRI; smoking; multivessel coronary artery disease, and CKD. The NT-proBNP level and the peak troponin I level were independent predictors of all complications during the hospital stage of treatment.
Conclusion
. Risk factors and predictors associated with the development of life-threatening complications and the progression of heart failure during the hospital stage of treatment in young patients with ST-segment elevation myocardial infarction have been developed.
E. Miadzvedzeva, L. Gelis, T. V. Kuznetsova et al.· Emergency Cardiology and Car...· 0 citations
A retrospective study included 171 patients with acute coronary syndrome who underwent primary percutaneous coronary intervention between 2019 and 2023. Elderly and long-lived patients with ST-ECS and NSTE-ACS are characterized by significant comorbidity, with significantly more severe coronary pathology, as measured by the Syntax Score. In-hospital and long-term mortality were significantly higher in patients over 75 years of age. However, the incidence of late stroke and bleeding did not differ statistically between the study groups. Patients 75 years and older are a complex, heterogeneous group with a very high risk of in-hospital and long-term mortality, requiring a balanced and individualized approach from medical personnel at all stages of treatment.
T. R. Vildanov, N. Lukyanov, K. Kozlov et al.· Advances in gerontology = Us...· 0 citations
Background: Acute myocardial infarction (AMI) remains a major cause of morbidity and mortality worldwide. AMI is broadly classified into ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), which differ in pathophysiology, clinical presentation, management and prognosis. This study aimed to compare the in-hospital outcomes of patients with acute STEMI and NSTEMI. Methods: This prospective observational study was conducted in the Department of Cardiology, Chittagong Medical College Hospital, Bangladesh. A total of 100 patients with acute myocardial infarction were enrolled, including 50 STEMI patients (Group A) and 50 NSTEMI patients (Group B). Patients were selected according to WHO diagnostic criteria for myocardial infarction. Demographic characteristics, cardiovascular risk factors, clinical parameters, echocardiographic findings in-hospital complications, duration of hospital stay and mortality were analyzed. Statistical analysis was performed using SPSS and a p-value <0.05 was considered statistically significant. Results: The mean age was 49.98±11.90 years in the STEMI group and 51.90±8.58 years in the NSTEMI group (p=0.357). Male predominance was significantly higher in the STEMI group (94% vs. 68%, p=0.001). Smoking (84% vs. 62%, p=0.013) and dyslipidemia (64% vs. 40%, p=0.016) were significantly more common among STEMI patients, whereas obesity was more prevalent in NSTEMI patients (54% vs. 32%, p=0.026). Cardiogenic shock occurred significantly more frequently in STEMI patients (12% vs. 0%, p=0.012). Left ventricular systolic function was significantly lower in STEMI patients with mean ejection fraction of 50.96±9.82% compared with 55.50±11.30% in NSTEMI patients (p=0.035). STEMI patients had a longer hospital stay (5.02±0.82 vs. 4.34±0.66 days, p<0.001). No significant differences were observed regarding arrhythmias, congestive heart failure, pericardial effusion, hypotension, ventricular septal rupture or in-hospital mortality. Conclusion: Although overall in-hospital outcomes were broadly comparable between STEMI and NSTEMI patients, STEMI was associated with a higher incidence of cardiogenic shock, impaired left ventricular function and longer hospitalization. Early identification and intensive monitoring of STEMI patients may help reduce adverse in-hospital outcomes and improve prognosis.
Smaprity Islam, K. Mamun, M. Chowdhury et al.· Islami Bank Medical College...· 0 citations
