Portal de investigación
Comorbidity burden and revascularization benefit in elderly patients with acute coronary syndrome.
Fecha de publicación:
Autores de INCLIVA
Participantes ajenos a INCLIVA
- Garcia Acuna, Jose Maria
- Raposeiras, Sergio
- Barrabes, Jose A
- Cordero, Alberto
- Martinez-Selles, Manuel
- Bardaji, Alfredo
- Diez-Villanueva, Pablo
- Marin, Francisco
- Ruiz-Nodar, Juan M
- Vicente-Ibarra, Nuria
- Alonso Salinas, Gonzalo L
- Rigueiro, Pedro
- Abu-Assi, Emad
- Formiga, Frances
- Nunez, Eduardo
- Ariza-Sole, Albert
Grupos y Plataformas de I+D+i
Abstract
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 11Spanish 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 (Pfor 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. Copyright © 2020 Sociedad Espanola de Cardiologia. Published by Elsevier Espana, S.L.U. All rights reserved.
© 2020 Sociedad Española de Cardiología. Publicado por Elsevier España, S.L.U. Todos los derechos reservados.
Datos de la publicación
- ISSN/ISSNe:
- 1885-5857, 1579-2242
- Tipo:
- Article
- Páginas:
- 765-772
- PubMed:
- 32778402
REVISTA ESPANOLA DE CARDIOLOGIA Elsevier Doyma
Citas Recibidas en Web of Science: 29
Documentos
Filiaciones
Keywords
- Elderly; Comorbidities; Acute coronary syndrome; Revascularization
Financiación
Proyectos y Estudios Clínicos
INCORPORACIÓN DE NUEVAS ÁREAS TEMÁTICAS Y NUEVOS GRUPOS AL CONSORCIO CIBER
Investigador Principal: JUAN SANCHIS FORES
CB16/11/00420 . INSTITUTO SALUD CARLOS III
Cita
Sanchis J,Garcia JM,Raposeiras S,Barrabes JA,Cordero A,Martinez M,Bardaji A,Diez P,Marin F,Ruiz JM,Vicente N,Alonso GL,Rigueiro P,Abu E,Formiga F,Nunez J,Nunez E,Ariza A. Comorbidity burden and revascularization benefit in elderly patients with acute coronary syndrome. Rev. Esp. Cardiol. 2021. 74. (9):p. 765-772. IF:6,975. (1).
Comorbidity burden and revascularization benefit in elderly patients with acute coronary syndrome. Sanchis J, Garcia JM, Raposeiras S, Barrabes JA, Cordero A, Martinez M, Bardaji A et al. REVISTA ESPANOLA DE CARDIOLOGIA. 2021 enero 01. 74 (9):765-772. DOI:10.1016/j.rec.2020.06.015. PMID:32778402.
