[Which elderly with stable angina should be referred for cardiac surgery?]

Autor: Halna du Fretay X; Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France; Centre hospitalier universitaire Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France; Hôpital Foch, 40, rue Worth, 92150 Suresnes, France. Electronic address: xdufretay@orange.fr., Schnebert B; Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France., Genée O; Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France., Boyo M; Unité cardiologique de la Reine-Blanche, 555, avenue Jacqueline-Auriol, 45770 Saran, France.
Jazyk: francouzština
Zdroj: Annales de cardiologie et d'angeiologie [Ann Cardiol Angeiol (Paris)] 2018 Dec; Vol. 67 (6), pp. 429-438. Date of Electronic Publication: 2018 Oct 17.
DOI: 10.1016/j.ancard.2018.09.018
Abstrakt: The choice of revascularization of coronary patients, if it is well codified in the general population, remains in the elderly subject a daily dilemma for the clinician. We report 4 clinical cases (80 years and over) elective for coronary artery bypass or percutaneous coronary transluminal angioplasty (PTCA). No randomized studies dedicated to this population are available. Nevertheless, according to the registries, surgery versus PTCA has a superior benefit in the medium and long term, despite higher mortality and stroke. The coronary lesions in this population are actually more complex, usually leading to surgery compared to a younger population. However, the choice of the revascularization method is difficult depending on the co-morbidities and the higher surgical risk. What must be taken into account here are the cognitive abilities, the risk of cognitive decline, the frailty of the patient (correlated with mortality), frailty being a subjective data given without a consensually recognized scoring system. The indication of the revascularization method should include mortality risks as well as morbidity, in particular the potential risk of deterioration of the general condition and autonomy of patients, particularly the elderly. Randomized studies dedicated to this population, taking into account mortality and morbidity, and in particular the "concept of frailty", would make it possible to describe the specificities of aging subjects in recommendations and good practices.
(Copyright © 2018 Elsevier Masson SAS. All rights reserved.)
Databáze: MEDLINE
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