Temporal trends in the treatment and outcomes of elderly patients with acute coronary syndrome.
Details
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State: Public
Version: author
Serval ID
serval:BIB_4041C0BFFA03
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Temporal trends in the treatment and outcomes of elderly patients with acute coronary syndrome.
Journal
European heart journal
Working group(s)
AMIS Plus Investigators
Contributor(s)
Lessing P., Hess F., Simon R., Hangartner P., Hufschmid U., Hornig B., Jeger R., Trummler S., Windecker S., Rueff T., Loretan P., Roethlisberger C., Evéquoz D., Mang G., Ryser D., Jecker R., Kistler W., Droll A., Stäuble S., Freiwald G., Schmid H., Stauffer J., Cook S., Bietenhard K., Roffi M., Wojtyna W., Schönenberger R., Waldburger R., Schmidli M., Federspiel B., Weiss E., Weber K., Zender H., Poepping I., Hugi A., Koltai E., Pedrazzini G., Erne P., Cuculi F., Heimes T., Pagnamenta A., Urban P., Stettler C., Repond F., Widmer F., Heimgartner C., Polikar R., Bassetti S., Iselin H., Giger M., Egger P., Kaeslin T., Fischer A., Herren T., Eichhorn P., Neumeier C., Flury G., Girod G., Vogel R., Niggli B., Rickli H., Yoon S., Nossen J., Stoller U., Bächli E., Weber A., Schmidt D., Hellermann J., Eriksson U., Fischer T., Peter M., Gasser S., Fatio R., Vogt M., Ramsay D., Bertel O., Maggiorini M., Eberli F., Christen S.
ISSN
1522-9645 (Electronic)
ISSN-L
0195-668X
Publication state
Published
Issued date
21/04/2016
Peer-reviewed
Oui
Volume
37
Number
16
Pages
1304-1311
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Publication Status: ppublish
Abstract
To determine whether treatment and outcomes of older acute coronary syndrome (ACS) patients changed over time.
We analysed the use of guideline-recommended therapies and in-hospital outcomes of 13 662 ACS patients ≥70 years enrolled in the prospective Acute Myocardial Infarction in Switzerland (AMIS) cohort between 2001 and 2012 according to 4-year periods (2001-2004, 2005-2008, and 2009-2012). Between first and last 4-year period, percutaneous coronary intervention (PCI) use increased from 43.8 to 69.6% of older ACS patients ( ITALIC! P < 0.001). Use of guideline-recommended drugs as well increased. At the same time, in-hospital mortality of the overall population decreased from 11.6% in the first to 10.0% in the last 4-year period ( ITALIC! P = 0.020), and in-hospital major adverse cardiac and cerebrovascular events from 14.4 to 11.3% ( ITALIC! P < 0.001). Percutaneous coronary intervention was used in increasingly older and co-morbid patients over time (mean age of patients treated with PCI 76.2 years in 2001-2004 and 78.1 years in 2009-2012, ITALIC! P < 0.001; Charlson score ≥2 was found for 27.6% of patients treated with PCI in 2001-2004 and for 32.1% in 2009-2012, ITALIC! P = 0.003). Percutaneous coronary intervention use was associated with similar odds ratios (ORs) of in-hospital mortality over time (adjusted OR 0.29, 95% confidence interval, CI, 0.22-0.40, in 2001-2004; and, adjusted OR 0.26, 95% CI 0.20-0.35, in 2009-2012).
Use of guideline-recommended therapies for ACS increased and in-hospital outcomes improved over the observed 12-year period. Though PCI was used in increasingly older and co-morbid patients, PCI use was associated with similar ORs of in-hospital mortality over time. This study suggests that increasing use of guideline-recommended therapies was appropriate.
ClinicalTrials.gov Identifier: NCT01305785.
We analysed the use of guideline-recommended therapies and in-hospital outcomes of 13 662 ACS patients ≥70 years enrolled in the prospective Acute Myocardial Infarction in Switzerland (AMIS) cohort between 2001 and 2012 according to 4-year periods (2001-2004, 2005-2008, and 2009-2012). Between first and last 4-year period, percutaneous coronary intervention (PCI) use increased from 43.8 to 69.6% of older ACS patients ( ITALIC! P < 0.001). Use of guideline-recommended drugs as well increased. At the same time, in-hospital mortality of the overall population decreased from 11.6% in the first to 10.0% in the last 4-year period ( ITALIC! P = 0.020), and in-hospital major adverse cardiac and cerebrovascular events from 14.4 to 11.3% ( ITALIC! P < 0.001). Percutaneous coronary intervention was used in increasingly older and co-morbid patients over time (mean age of patients treated with PCI 76.2 years in 2001-2004 and 78.1 years in 2009-2012, ITALIC! P < 0.001; Charlson score ≥2 was found for 27.6% of patients treated with PCI in 2001-2004 and for 32.1% in 2009-2012, ITALIC! P = 0.003). Percutaneous coronary intervention use was associated with similar odds ratios (ORs) of in-hospital mortality over time (adjusted OR 0.29, 95% confidence interval, CI, 0.22-0.40, in 2001-2004; and, adjusted OR 0.26, 95% CI 0.20-0.35, in 2009-2012).
Use of guideline-recommended therapies for ACS increased and in-hospital outcomes improved over the observed 12-year period. Though PCI was used in increasingly older and co-morbid patients, PCI use was associated with similar ORs of in-hospital mortality over time. This study suggests that increasing use of guideline-recommended therapies was appropriate.
ClinicalTrials.gov Identifier: NCT01305785.
Keywords
Acute Coronary Syndrome, Aged, Humans, Myocardial Infarction, Percutaneous Coronary Intervention, Prospective Studies, Switzerland, Treatment Outcome, Aged 80 and over, Cohort studies, Coronary angiography, Elderly, Myocardial ischaemia
Pubmed
Web of science
Open Access
Yes
Create date
19/01/2016 16:44
Last modification date
20/08/2019 13:38
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