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Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term mortality.

Barywani SB, Li S, Lindh M, Ekelund J, Petzold M, Albertsson P, Lund LH, Fu ML - Clin Interv Aging (2015)

Bottom Line: Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5).Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction ≤45%, estimated glomerular filtration rate ≤35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins.In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden.

ABSTRACT

Aim: Evidence of improved survival after use of percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS) is limited. We assessed the association between PCI and long-term mortality in octogenarians with ACS.

Methods and results: We followed 353 consecutive patients aged ≥80 years hospitalized with ACS during 2006-2007. Among them, 182 were treated with PCI, whereas 171 were not. PCI-treated patients were younger and more often male, and had less stroke and dependency in activities of daily living, but there were no significant differences in occurrence of diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and uncured malignancies between the two groups. The association between PCI and all-cause mortality was assessed in the overall cohort and a 1:1 matched cohort based on propensity score (PS). In overall cohort, 5-year all-cause mortality was 46.2% and 89.5% in the PCI and non-PCI groups, respectively. Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5). In propensity-matched cohort, 5-year all-cause mortality was 54.9% and 83.1% in the PCI and non-PCI groups, respectively. Kaplan-Meier survival curves and log rank test showed significantly improved mean survival rates (P=0.001): 48 months (95% CI 41-54) for PCI-treated patients versus 35 months (95% CI 29-42) for non-PCI-treated patients. Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction ≤45%, estimated glomerular filtration rate ≤35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins.

Conclusion: In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.

No MeSH data available.


Related in: MedlinePlus

Distribution of propensity scores in the matched and overall cohort.Abbreviation: PCI, percutaneous coronary intervention.
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f1-cia-10-1547: Distribution of propensity scores in the matched and overall cohort.Abbreviation: PCI, percutaneous coronary intervention.

Mentions: The results are presented as percentages and the mean ± standard deviation. In the case of continuous variables that visual inspection of their histograms, normal Q–Q plots and box plots showed that the variables were approximately normally distributed. Statistical analysis was performed using Student’s unpaired t-test. Mann–Whitney test was used for non-normally distributed continuous variables. For discrete variables, the chi-square test was used. A P-value <0.05 was regarded as statistically significant. The hazard ratios (HRs) from Cox survival analysis with confidence intervals (CIs) and P-values were presented. Propensity score (PS)-matching analysis with 1:1 nearest neighbor matching was employed. Variables used in developing the PS are presented in Table 1. These variables were chosen based on clinical relevance. As shown in Figure 1, the covariate balance was improved in the matched sample, that the region of common support spanned almost the entire distribution of the PS, and that it was only in the extreme tail regions that no appropriate matching could be found. After PS matching, 142 patients remained including 71 in the PCI-treated and 71 in non-PCI-treated groups.


Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term mortality.

Barywani SB, Li S, Lindh M, Ekelund J, Petzold M, Albertsson P, Lund LH, Fu ML - Clin Interv Aging (2015)

Distribution of propensity scores in the matched and overall cohort.Abbreviation: PCI, percutaneous coronary intervention.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4592028&req=5

f1-cia-10-1547: Distribution of propensity scores in the matched and overall cohort.Abbreviation: PCI, percutaneous coronary intervention.
Mentions: The results are presented as percentages and the mean ± standard deviation. In the case of continuous variables that visual inspection of their histograms, normal Q–Q plots and box plots showed that the variables were approximately normally distributed. Statistical analysis was performed using Student’s unpaired t-test. Mann–Whitney test was used for non-normally distributed continuous variables. For discrete variables, the chi-square test was used. A P-value <0.05 was regarded as statistically significant. The hazard ratios (HRs) from Cox survival analysis with confidence intervals (CIs) and P-values were presented. Propensity score (PS)-matching analysis with 1:1 nearest neighbor matching was employed. Variables used in developing the PS are presented in Table 1. These variables were chosen based on clinical relevance. As shown in Figure 1, the covariate balance was improved in the matched sample, that the region of common support spanned almost the entire distribution of the PS, and that it was only in the extreme tail regions that no appropriate matching could be found. After PS matching, 142 patients remained including 71 in the PCI-treated and 71 in non-PCI-treated groups.

Bottom Line: Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5).Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction ≤45%, estimated glomerular filtration rate ≤35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins.In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Sahlgrenska University Hospital/Östra Hospital, Gothenburg, Sweden.

ABSTRACT

Aim: Evidence of improved survival after use of percutaneous coronary intervention (PCI) in elderly patients with acute coronary syndrome (ACS) is limited. We assessed the association between PCI and long-term mortality in octogenarians with ACS.

Methods and results: We followed 353 consecutive patients aged ≥80 years hospitalized with ACS during 2006-2007. Among them, 182 were treated with PCI, whereas 171 were not. PCI-treated patients were younger and more often male, and had less stroke and dependency in activities of daily living, but there were no significant differences in occurrence of diabetes mellitus, chronic obstructive pulmonary disease, hypertension, and uncured malignancies between the two groups. The association between PCI and all-cause mortality was assessed in the overall cohort and a 1:1 matched cohort based on propensity score (PS). In overall cohort, 5-year all-cause mortality was 46.2% and 89.5% in the PCI and non-PCI groups, respectively. Cox regression analysis in overall cohort by adjustment for ten baseline variables showed statistically significant association between PCI and reduced long-term mortality (P<0.001, hazard ratio 0.4, 95% confidence interval [CI] 0.2-0.5). In propensity-matched cohort, 5-year all-cause mortality was 54.9% and 83.1% in the PCI and non-PCI groups, respectively. Kaplan-Meier survival curves and log rank test showed significantly improved mean survival rates (P=0.001): 48 months (95% CI 41-54) for PCI-treated patients versus 35 months (95% CI 29-42) for non-PCI-treated patients. Furthermore, by performing Cox regression analysis, PCI was still associated with reduced long-term mortality (P=0.029, hazard ratio 0.5, 95% CI 0.3-0.9) after adjustment for PS and confounders: age, male sex, cognitive deterioration, uncured malignancies, left ventricular ejection fraction ≤45%, estimated glomerular filtration rate ≤35 mL/min, ST-segment elevation myocardial infarction, mitral regurgitation, and medication at discharge with clopidogrel and statins.

Conclusion: In octogenarians with ACS, PCI was associated with improved survival from all-cause death over 5 years of follow-up.

No MeSH data available.


Related in: MedlinePlus