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Coronary angiography in the very old: impact of diabetes on long-term revascularization and mortality

Journal of Geriatric Cardiology 2019年第1期16卷 27-32页

作者： elad shemesh Barak Zafrir Department of Cardiovascular Medicine Lady Davis Carmel Medical Center

Background Diabetes is often associated with coronary artery disease,leading to adverse clinical outcomes.Real-world data is limited regarding the impact of diabetes in very old patients undergoing coronary angiography on the risk for late or repeated coronary revascularization and mortality.Methods Retrospective analysis of 1,353 consecutive patients>80 years who were admitted to the cardiac unit and further underwent coronary angiography.Subsequent revascularization procedures and all-cause mortality were recorded over a median fbllow-up of 47 months and their relation to diabetic status and presentation with acute coronary syndrome(ACS)was studied.Results Diabetes was present in 31%of the patients undergoing coronary angiography,and was associated with higher rates of obesity,hypertension,hyperlipidemia,chronic kidney disease and female gender.ACS was the presenting diagnosis in 71%of the patients and was associated with worse survival(1-year mortality 20%in ACS vs.6.2%in non-ACS patients,P<0.0001).Increase in long-term mortality rates was seen in diabetic subjects compared to non-diabetic subjects presenting with ACS(log-rank P=0.005),but not in the non-ACS setting(P=0」99).In a multivariable model,additionally adjusting for acuity of presentation,the presence of diabetes was associated with an adjusted hazard ratio of 1.60(95%confidence interval:12-2.28),P=0.011,for the need of late or repeat coronary revascularization and 1.48(1.26-1.74),P<0.0001 for all-cause mortality,during long-term follow-up.Conclusions In very old patients undergoing coronary angiography,presentation with ACS was associated with worse survival.Diabetes was an independent predictor of late or repeated revascularization and long-term mortality.

关键词： Cardiac catheterization Coronary artery disease Coronary revascularization Diabetes mellitus Mortality Very old age

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Trabeculectomy with Ex-PRESS implant versus Ahmed glaucoma valve implantation-a comparative study

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International Journal of Ophthalmology(English edition) 2016年第10期9卷 1415-1420页

作者： Michael Waisbourd Naomi Fischer Hadas Shalev Oriel Spierer elad Ben Artsi Rony Rachmiel Gabi shemesh Shimon Kurtz Department of Ophthalmology Tel-Aviv Medical CenterAffiliated to the Sackler Faculty of Medicine Tel-Aviv University Tel-Aviv 64239 Israel Wills Eye Glaucoma Research Center Philadelphia PA19107 USA

AIM：To compare the surgical outcomes of trabeculectomy with Ex-PRESS implant and Ahmed glaucoma valve（AGV） implantation. METHODS： Patients who underwent trabeculectomy with Ex-PRESS implants or AGV implantation separately were included in this retrospective chart review.Main outcome measures were surgical failure and complications.Failure was defined as intraocular pressure（IOP）〉21 mm Hg or 〈5 mm Hg on two consecutive visits after 3mo,reoperation for glaucoma,or loss of light perception.Eyes that had not failed were considered as complete success if they did not required supplemental medical therapy.RESULTS： A total of 64 eyes from 57 patients were included： 31 eyes in the Ex-PRESS group and 33 eyes in the AGV group.The mean follow-up time was 2.6 ±1.1y and 3.3±1.6y,respectively.Patients in the AGV group had significantly higher baseline mean IOP（P =0.005）,lower baseline mean visual acuity（VA）（P =0.02）,and higher proportion of patients with history of previous trabeculectomy（P 〈0.0001）.Crude failure rates were 16.1%,n =5/31 in the Ex-PRESS group and 24.2%,n =8/33 in the AGV group.The cumulative proportion of failure was similar between the groups,P =0.696.The proportion of eyes that experienced postoperative complications was32.3% in the Ex-PRESS group and 60.1% in the AGV group（P =0.0229）.CONCLUSION： Trabeculectomy with Ex-PRESS implant and AGV implantation had comparable failure rates.The AGV group had more post-operative complications,but also included more complex cases with higher baselinemean IOP,worse baseline mean VA,and more previous glaucoma surgeries.Therefore,the results are limited to the cohort included in this study.

关键词： Ex-PRESS glaucoma implant trabeculectomy Ahmed glaucoma valve implantation

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