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Cardiovascular Care for Older Adults Aortic valve disease in the older adult

Journal of Geriatric Cardiology 2016年第12期13卷 941-944页

作者： Neal Bhatia Sukhdeep S Basra adam h.skolnick Nanette K Wenger Emory University School of Medicine Atlanta GA USA The heart hospital Baylor Piano Dallas TX USA Leon h Charney Division of Cardiology New York University Langone Medical Center NY USA

As the population continues to age,aortic stenosis remains as the most prevalent valvular disease in Western countries. The number of elderly patients with aortic stenosis continues to pose both a diagnostic and therapeutic challenge. Despite new advances such as transcatheter aortic valvular replacement (TAVR),there is still much patient-provider decision making that needs to take place given the comorbidities and complex goals of care in an elderly patient population.

关键词： Aortic stenosis The elderly Valve disease

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Angiographic and clinical outcomes in elderly subjects treated with percutaneous coronary intervention following fibrinolytic administration for ST-elevation myocardial infarction

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Journal of Geriatric Cardiology 2005年第1期2卷 10-14页

作者： Ajay J.Kirtane adam h.skolnick hilary Oman Christopher Ruisi Leida Perez Nicole Kraimer Dimitrios Karmpaliotis Duane S.Pinto Eugene Braunwald C.Michael Gibson Cardiovascular Division Department of Medicine Beth Israel Deaconess Medical Center and Harvard Medical SchoolBostonMAUSA TIMI Study Group Cardiovascular Division Department of MedicineBrighton and Women's HospitalBostonMAUSA TIMI Study Group Cardiovascular Division Department of MedicineBrigham and Women's HospitalBostonMAUSA

Background Prior studies have demonstrated that the achievement of faster coronary artery flow following reperfusion therapies is associated with improved outcomes among ST-elevation myocardial infarction (STEMI) patients. The association of patient age with angiographic characteristics of flow and perfusion after rescue/adjunctive percutaneous coronary intervention (PCI) following the administration of fibrinolytic therapy has not been previously investigated. Objectives and Methods We examined the association between age (≥ 70 years or ＜ 70years)and clinical and angiographic outcomes in 1472 STEMI patients who underwent rescue/adjunctive PCI following fibrinolytic therapy in 7 TIMI trials. We hypothesized that elderly patients would have slower post-PCI epicardial flow and worsened outcomes compared to younger patients. Results The 218 patients aged ≥ 70 years (14.8%) had more comorbidities than younger patients. Although these patients had significant angiographic improvement in TIMI frame counts and rates of TIMI Grade 3 flow following rescue/adjunctive PCI, elderly patients had higher (slower)post-PCI TIMI frame counts compared to the younger cohort (25 vs 22 frames, P = 0.039), and less often achieved post-PCI TIMI Grade 3 flow (80.1 vs 86.4%, P = 0.017). The association between age ( ≥70 years) and slower post-PCI flow was independent of gender, time to treatment, left anterior descending (LAD) lesion location, and pulse and blood pressure on admission. Elderly patients also had 4-fold higher mortality at 30 days (12.0 vs 2.7%,P = 0. 001 ). Conclusions This study suggests one possible mechanism underlying worsened outcomes among elderly STEMI patients insofar as advanced chronological age was associated with higher TIMI frame counts and less frequent TIMI Grade 3 flow after rescue/adjunctive PCI.

关键词： TIMI flow grade TIMI frame count percutaneous coronary intervention age elderly

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星条旗下的阴影美国的社会事务与公共政策

星条旗下的阴影美国的社会事务与公共政策

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1994年

作者：（美）卡瑞（Currie E.）（美）斯科尔尼克（skolnick J.h.）张凤国等译

书名原文:America's problem:Social issues and public policy:本书从社会制度和政治结构入手,宏观地分析了在美国政治、经济等领域里广泛存在的不平等现象,并着重分析了一些人们普通关注的家庭、工作、健康、环境、国防开支与国民经... 详细信息

书名原文:America's problem:Social issues and public policy:本书从社会制度和政治结构入手,宏观地分析了在美国政治、经济等领域里广泛存在的不平等现象,并着重分析了一些人们普通关注的家庭、工作、健康、环境、国防开支与国民经济的关系等具体的重大社会问题。

关键词：社会问题学科:研究地点:美国

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