Carga de comorbilidad y beneficio de la revascularización en ancianos con síndrome coronario agudo
Autor: | Manuel Martínez-Sellés, Eduardo Núñez, Gonzalo Luis Alonso Salinas, Nuria Vicente-Ibarra, Francisco Marín, Pablo Díez-Villanueva, Sergio Raposeiras, José María García Acuña, Albert Ariza-Solé, Juan Sanchis, Juan M. Ruiz-Nodar, Pedro Rigueiro, José A. Barrabés, F Formiga, Alfredo Bardají, Alberto Cordero, Julio Núñez, Emad Abu-Assi |
---|---|
Jazyk: | angličtina |
Rok vydání: | 2020 |
Předmět: |
medicine.medical_specialty
Acute coronary syndrome Anemia medicine.medical_treatment Enfermedad cardiovascular Anciano Comorbidity 030204 cardiovascular system & hematology Cardiología Revascularization 03 medical and health sciences Percutaneous Coronary Intervention 0302 clinical medicine Diabetes mellitus Internal medicine medicine Humans Síndrome coronario agudo Registries Acute Coronary Syndrome Propensity Score Stroke Aged Retrospective Studies business.industry Retrospective cohort study General Medicine medicine.disease Treatment Outcome Revascularización miocárdica Propensity score matching Cardiology business |
Popis: | Introduction and objectives: To evaluate the interaction between comorbidity burden and the benefits of in-hospital revascularization in elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Methods: This retrospective study included 7211 patients aged ≥ 70 years from 11 Spanish NSTEACS registries. Six comorbidities were evaluated: diabetes, peripheral artery disease, cerebrovascular disease, chronic pulmonary disease, renal failure, and anemia. A propensity score was estimated to enable an adjusted comparison of in-hospital revascularization and conservative management. The end point was 1-year all-cause mortality. Results: In total, 1090 patients (15%) died. The in-hospital revascularization rate was 60%. Revascularization was associated with lower 1-year mortality; the strength of the association was unchanged by the addition of comorbidities to the model (HR, 0.61; 95%CI, 0.53-0.69; P=.0001). However, the effects of revascularization were attenuated in patients with renal failure, peripheral artery disease, and chronic pulmonary disease (P for interaction=.004, .007, and .03, respectively) but were not modified by diabetes, anemia, and previous stroke (P=.74, .51, and .28, respectively). Revascularization benefits gradually decreased as the number of comorbidities increased (from a HR of 0.48 [95%CI, 0.39-0.61] with 0 comorbidities to 0.83 [95%CI, 0.62-1.12] with ≥ 5 comorbidities; omnibus P=.016). The results were similar for the propensity score model. The same findings were obtained when invasive management was considered the exposure variable. Conclusions: In-hospital revascularization improves 1-year mortality regardless of comorbidities in elderly patients with NSTEACS. However, the revascularization benefit is progressively reduced with an increased comorbidity burden. Renal failure, peripheral artery disease, and chronic lung disease were the comorbidities with the most detrimental effects on revascularization benefits. Sin financiación No data JCR 2021 0.385 SJR (2021) Q3, 1499/2489 Medicine (miscellaneous) No data IDR 2021 UEM |
Databáze: | OpenAIRE |
Externí odkaz: |