Year: 2015
Type: dissertation
Study design: Observational Study
Abstract: Aim: The overall aim of this thesis was to study the prognostic prediction and its association\nwith treatment strategies in the elderly patients presenting with acute coronary syndrome\n(ACS) and left ventricular systolic heart failure (HF).\nMethods: A total 353 octogenarians with ACS, 182 patients treated with percutaneous\ncoronary intervention (PCI) and 171 treated without PCI, were consecutively included\nand retrospectively studied for prognostic predictors of long-term all-cause mortality.\nMoreover, 140 patients >70 years were prospectively studied for prognostic predictors\nfor major adverse cardiovascular events (MACE) in patients with ACS referred for coronary\nangiography. In case of heart failure, 182 octogenarians with left ventricular systolic\nHF were consecutively included and retrospectively studied for impact of different dose\nlevels of guideline recommended neurohormonal blockades, beta-blockers (BBs) and angiotensin\nconverting enzyme inhibitors (ACEIs)/ angiotensin receptor blockers (ARBs),\non long-term mortality.\nResults: In ACS-cohorts: Cox-regression analysis of octogenarian patients with ACS\ntreated with PCI showed following factors as independent predictors of 5-year all-cause\nmortality: atrial fi brillation, mitral regurgitation (MR), tricuspid regurgitation (TR), estimated\nglomerular fi ltration rate (eGFR) <30 ml/min and dependency in activities of daily\nliving. Furthermore, in the overall cohort of octogenarians with ACS, both PCI-treated\nand non-PCI-treated, PCI was associated with lower 5-year all-cause mortality. At least\nmild grade MR was associated with higher 5-year all-cause mortality and PCI was associated\nwith improved prognosis even in patients with MR compared with patients with MR\ntreated without PCI. Finally, in a prospective cohort of ACS patients >70 years referred\nfor coronary angiography, during an average follow-up of 39+11 months, 41% of the\npatients had one or more MACE and 24% developed post-ACS heart failure. The study\ncohort had as good quality of life as an age-matched reference population from Swedish\nnormative SF-36 database in both physical health subscales (physical functioning, role\nphysical, bodily pain and general health) and mental health subscales (Vitality, social\nfunctioning, role emotional and mental health). The all-cause mortality rate was 10%.\nIn heart failure cohort: In octogenarians with left ventricular systolic HF treated with\nhighest tolerable doses of neurohormonal blockades, target dose of ACEIs/ARBs were associated\nwith improved 5-year survival rate, despite that this was achievable in only about\nhalf of the patients. No signifi cant differences in survival were found between the different\ndoses of BBs; however the heart rate was comparable between the different dose groups.\nConclusion: In elderly patients with ACS, PCI was associated with improved long-term\nsurvival despite high age. Several prognostic predictors including MR were identifi ed.\nMoreover, in the modern era of reperfusion therapy, despite improved quality of life and\nlow mortality rate MACE occurred frequently in elderly patients after ACS indicating further\nneed of tailored care. In octogenarian patients with systolic HF, target dose of ACEIs/\nARBs was associated with reduced fi ve-year all-cause mortality, but this dose survival\nrelationship did not fi nd in case of the beta-blockers.
Author: Salim Bary Barywani
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2183027370