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Antithrombotic treatment tailoring and risk score evaluation in elderly patients diagnosed with an acute coronary syndrome

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Journal of Geriatric Cardiology 2017年第7期14卷 442-456页

作者： Alexandru Nicolae Mischie Catalina Liliana Andrei Crina Sinescu Gani Bajraktari Eugen Ivan Georgios Nikolaos Chatziathanasiou Michele Schiariti Invasive Cardiology Unit Centre Hospitalier de Montlufon Montlufon France Carol Davila University of Medicine and Pharmacy Bucharest Romania Clinic of Cardiology University Clinical Centre of Kosova Prishtina Republic of Kosovo Comanche Memorial Hospital Lawton USA 5Cardiology Clinic Preveza Greece Cardiology Clinic Preveza Greece Department of Cardiovascular Sciences Sapienza University of Rome Rome Italy

Age is an important prognostic factor in the outcome of acute coronary syndromes （ACS）. A substantial percentage of patients who ex- perience ACS is more than 75 years old, and they represent the fastest-growing segment of the population treated in this setting. These pa- tients present different patterns of responses to pharmacotherapy, namely, a higher ischemic and bleeding risk than do patients under 75 years of age. Our aim was to identify whether the currently available ACS ischemic and bleeding risk scores, which has been validated for the general population, may also apply to the elderly population. The second aim was to determine whether the elderly benefit more from a spe- cific pharmacological regimen, keeping in mind the numerous molecules of antiplatelet and antithrombotic drugs, all validated in the general population. We concluded that the GRACE （Global Registry of Acute Coronary Events） risk score has been extensively validated in the elderly. However, the CRUSADE （Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early imple- mentation of the ACC/AHA Guidelines） bleeding score has a moderate correlation with outcomes in the elderly. Until now, there have not been head-to-head scores that quantify the ischemic versus hemorrhagic risk or scores that use the same end point and timeline （e.g., ischemic death rate versus bleeding death rate at one month）. We also recommend that the frailty score be considered or integrated into the current existing scores to better quantify the overall patient risk. With regard to medical treatment, based on the subgroup analysis, we identified the drugs that have the least adverse effects in the elderly while maintaining optimal efficacy.

关键词： Acute coronary syndrome Antithrombotic treatment elderly patients Risk score evaluation

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Impact of admission blood glucose levels on prognosis of elderly patients with ST elevation myocardial infarction treated by primary percutaneous coronary intervention

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Journal of Geriatric Cardiology 2013年第4期10卷 310-316页

作者： Ahmet Ekmekci Mahmut Uluganyan Fatif Tufan Huseyin Uyarel Gurkan Karaca Seref Kul Barl(s) Gungor Department of Cardiology Dr.Siyami Ersek Thoracic and Cardiovascular Surgery Center Training and Research Hospital Tibbiye Caddesi 34000 Istanbul Turkey Department of Cardiology Kadirli State Hospital Toki Caddesi 8075 Osmaniye Turkey Department of Geriatric Istanbul University Medical Hospital Vatan Cadddessi 34000 Istanbul Turkey Department of Cardiology Bezmialem Vakif University Medical Hospital Vatan Caddesi 34000 Istanbul Turkey

OBJECTIVE:Admission hyperglycemia in acute myocardial infarction (MI) is related with increased in-hospital and long term mortality and major cardiac adverse events。 We aimed to investigate how admission hyperglycemia affects the short and long term outcomes in elderly patients >65 years) after primary percutaneous coronary intervention for ST elevation myocardial infarction。 METHODS:We retrospectively analyzed 677 consecutive elderly patients (mean age 72.2 ±5.4)。 patients were divided into two groups according to admission blood glucose levels。 Group : low glucose group (LLG), glucose 168 mg/dL。 RESULTS:In-hospital, long term mortality and in-hospital major adverse cardiac events were higher in the high admission blood glucose group (P 1, post-thrombolysis in MI elderly patients presented with ST elevation myocardial infarction is an independent predictor of in-hospital major adverse cardiac events and is associated with in-hospital and long term mortality。

关键词： Admission hyperglycemia elderly patients In-hospital mortality Long-term mortality Major adverse cardiac events

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Relationship between red blood cell distribution width and intermediate-term mortality in elderly patients after percutaneous coronary intervention

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Journal of Geriatric Cardiology 2015年第1期12卷 17-22页

作者： Xin-Min LIU Chang-Sheng MA Xiao-Hui LIU Xin DU Jun-Ping KANG Yin ZHANG Jia-Hui WU Department of Cardiology Beijing An Zhen Hospital Capital Medical University Beijing 100029 China

Background Large-scale clinical research on the relationship between red blood cell distribution width （RDW） and intermediate-term prognosis in elderly patients with coronary artery disease （CAD） is lacking. Thus, this study investigated the effects of RDW on the intermediate-term mortality of elderly patients who underwent elective percutaneous coronary intervention （PCI）. Methods Data from 1891 patients 〉 65 years old underwent elective PCI from July 2009 to September 2011 were collected. Based on preoperative median RDW （12.3%）, the patients were divided into two groups. The low RDW group （RDW 〈 12.3%） had 899 cases; the high RDW group （RDW 〉 12.3%） had 992 cases. The all-cause mortality rates of the two groups were compared. Results patients in the high RDW group were more likely to be female and accompanied with diabetes, had lower hemoglobin level. The mean follow-up period was 527 days. During follow-up, 61 patients died （3.2%）. The postoperative mortality of the high RDW group was significantly higher than that of the low RDW group （4.3% vs. 2.0%, P = 0.004）. After adjusting other factors, multivariate Cox regression analysis revealed that preoperative high RDW was significantly associated with postoperative all-cause mortality （hazard ratio： 2.301, 95% confidence interval： 1.106-4.785, P = 0.026）. Conclusions Increased RDW was an independent predictor of the increased intermediate-term all-cause mortality in elderly CAD patients after elective PCI.

关键词： Coronary artery disease elderly patients Percutaneous coronary intervention Red blood cell distribution width

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Risk of New-Onset Atrial Fibrillation in elderly patients with the Overlap Syndrome: A Retrospective Cohort Study

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Journal of Geriatric Cardiology 2013年第2期10卷 129-134页

作者： Harsha V. Ganga Sanjeev U. Nair Venkata K. Puppala Wayne L. Miller The Henry Low Heart Center Hartford Hospital B-1010 80 Seymour Street Hartford CT 06102 USA St. Joseph's Hospital 45 W 10th St St. Paul MN 55102 USA Division of Cardiovascular Diseases Mayo Clinic Rochester MN 55905 USA

Background Co-existence of obstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) is referred to as overlap syndrome. Overlap patients have greater degree of hypoxia and pulmonary hypertension than patients with OSA or COPD alone. Studies showed that elderly patients with OSA alone do not have increased risk of atrial fibrillation (AF) but it is not known if overlap patients have higher risk of AF. Objective To determine whether elderly patients with overlap syndrome have an increased risk of AF. Methods In this single center, community-based retrospective cohort analysis, data were collected on 2,873 patients > 65 years of age without AF, presenting in the year 2006. patients were divided into OSA group (n = 60), COPD group (n = 416), overlap syndrome group (n = 28) and group with no OSA or COPD(n = 2369). The primary endpoint was incidence of new-onset AF over the following two years. Logistic regression was performed to adjust for heart failure (HF), coronary artery disease, hypertension (HTN), cerebrovascular disease, cardiac valve disorders, diabetes mellitus, hyperlipidemia, chronic kidney disease (CKD) and obesity. Results The incidence of AF was 10% in COPD group, 6% in OSA group and 21% in overlap syndrome group (P patientswith overlap syndrome demonstrated a significant association with new-onset AF (OR = 3.66, P = 0.007). HF, CKD and HTNwere also significantly associated with new-onset AF (P elderly patients, the presence of overlap syndrome is associatedwith a marked increase in risk of new-onset AF as compared to the presence of OSA or COPDalone.

关键词： Atrial arrhythmias elderly patients Obstructive lung disease Sleep apnea

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Role of chemotherapy and novel biological agents in the treatment of elderly patients with colorectal cancer

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World Journal of Gastroenterology 2008年第12期14卷 1812-1822页

作者： Gerardo Rosati Domenico Bilancia Medical Oncology Unit S. Carlo Hospital Potenza 85100 Italy

patients older than 65 years are the fastest growing segment of the cancer population. It is estimated that within 20 years over 75% of cases and 85% of deaths from colorectal cancer (CRC) will be in this setting. Concerns about cancer treatment in the elderly relate to comorbidities, which increase proportionally with age, physiological changes associated with aging which may influence drug metabolism and toxicity, and diminishing life expectancy, which particularly impacts decisions surrounding the benefits of adjuvant therapies. Over the last 10 years, significant improvements in the treatment of advanced CRC with combination therapy have been made. The randomized trials which have defined these improvements did not exclude elderly patients. However, the median age of patients in these trials has generally been approximately 60 years. Thus, it appears that some degree of selection is involved with younger and presumably fitter patients being the subjects in most of the pivotal trials. The availability of new molecularly targeted agents and newly improved existing agents has expanded the range of treatment options available. This variety gives greater flexibility in dealing with different subsets of patients, such as the elderly. However, some fit elderly patients seem to tolerate combination therapy reasonably well, while studies on unfit elderly subjects are needed.

关键词： Bevacizumab Chemotherapy Cetuximab Colorectal cancer elderly patients

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Clinical Evaluation of a Vancomycin Dosage Strategy Based on a Serum Trough Concentration Model in elderly patients with Severe Pneumonia

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Biomedical and Environmental Sciences 2023年第5期36卷 397-405页

作者： YAN Wei SUN Xiao Yan WANG Meng ZHAO Fei Fan ZHOU Qing Tao Department of Respiratory and Critical Care Medicine Peking University Third HospitalBejing 100191China

Objective This study aimed to evaluate the clinical benefits of a vancomycin dosage strategy based on a serum trough concentration model in elderly *** This prospective single-center, open-label, randomized controlled trial categorized 66 elderly patients with severe pneumonia into study and control groups. The control group received vancomycin using a regimen decided by the attending physician. Meanwhile, the study group received individualized vancomycin therapy with a dosing strategy based on a serum trough concentration model. The primary endpoint was the proportion of patients with serum trough concentrations reaching the target *** secondary endpoints were clinical response, vancomycin treatment duration, and vancomycinassociated acute kidney injury(VA-AKI) *** All patients were at least 60 years old(median age = 81 years). The proportion of patients with target trough concentration achievement(≥ 15 mg/L) with the initial vancomycin regimen was significantly higher in the study group compared to the control group(75.8% vs. 42.4%, P = 0.006).Forty-five patients(68.2%) achieved clinical success, the median duration of vancomycin therapy was10.0 days, and VA-AKI occurred in eight patients(12.1%). However, there were no significant differences in these parameters between the two groups. The model for predicting vancomycin trough concentrations was upgraded to: serum trough concentration(mg/L) = 17.194-0.104 × creatinine clearance rate(mL/min) + 0.313 × vancomycin daily dose [mg/(kg·d)].Conclusion A vancomycin dosage strategy based on a serum trough concentration model can improve the proportion of patients achieving target trough concentrations in elderly patients with severe pneumonia.

关键词： Pneumonia Clinical trials Vancomycin Trough concentration elderly patients

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Neutrophil-to-lymphocyte ratio compared to N-terminal pro-brain natriuretic peptide as a prognostic marker of adverse events in elderly patients with chronic heart failure

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Journal of Geriatric Cardiology 2017年第2期14卷 127-134页

作者： Wei YAN Rui-Jun LI Qian JIA Yang MU Chun-Lei LIU Kun-Lun HE Department of Cardiology Chinese PLA General Hospital Beijing China School of Medicine Nankai University Tianjin China

Background The neutrophil-to-lymphocyte （N/L） ratio has been associated with poor prognosis in patients with heart failure, but it has not been compared with N-terminal pro-brain natriuretic peptide （NT-proBNP） in elderly patients with chronic heart failure （CHF）. We sought to make this comparison. Methods A total of 1355 elderly patients with CHF were analyzed. A multivariate logistic regression model was used to analyze the variables associated with atrial fibrillation （AF）. Cox regression analysis was used to assess the multivariable rela- tionship between the N/L ratio, NT-proBNP level, and subsequent major cardiovascular events （MCE）. Results In the multiple logistic regression analysis, the N/L ratio was demonstrated as a risk factor for AF in elderly patients with CHF [odds ratio （OR）： 1.079, 95% confi- dence interval （CI）： 1.027-1.134, P = 0.003]. The median follow-up period was 18 months. In a multivariable model using tertiles of both variables, the highest tertile of the N/L ratio was significantly associated with MCE [hazard ratio （HR）： 1.407, 95% CI： 1.098-1.802, P = 0.007] compared with the lowest tertile. Similarly, the highest NT-proBNP tertile was also significantly associated with MCE （HR： 1.461, 95% CI： 1.104-1.934, P- 0.008）. Conclusions In elderly patients with CHF, the N/L ratio is one of the important risk factors for AF and it is an inexpensive and readily available marker with similar independent prognostic power to NT-proBNP. The risk of MCE increases 1.407-fold when the N/L ratio is elevated to the highest tertile.

关键词： Atrial fibrillation Chronic heart failure elderly patients Neutrophil-to-lymphocyte ratio N-terminal pro-brain natriureticpeptide

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Gender differences in challenging behaviors,management and outcomes in elderly patients with delirium

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Neural Regeneration Research 2010年第10期5卷 796-800页

作者： Jihui Lv Qing Shen Daniel Kan Yin Chan Anne Hoolahan Xi Zheng Bin Ong Sharon Reutens Zheng Chen Department of Age Care and Rehabilitation Bankstown-Lidcombe Hospital Locked Bag 1600 Bankstown NSW 2200 Australia Department of Old Age Psychiatry Beijing Geriatric Hospital Beijing 100095 China Faculty of Medicine University of New South Wales NSW 2052 Australia Department of OIdAge Psychiatry Bankstown-Lidcombe Hospital Locked Bag 1600 Bankstown NSW

BACKGROUND： Gender differences have been reported in some common mental disorders. However, few studies have monitored gender differences in individuals with delirium. OBJECTIVE： To explore gender differences in challenging behaviors, management and outcomes in age-matched elderly patients with ***, TIME AND SETTING： A retrospective cohort study was performed in the Bankstown-Lidcombe Hospital, Sydney, Australia, from October 2008 to April 2009. METHODS： patients, aged 65-90 years, diagnosed with delirium according to the International Classification of Diseases （ICD）-10 in the Psychogeriatric Unit of Bankstown Lidcombe Hospital from January 2002 to October 2008 were reviewed. All the patients were measured according to the Confusion Assessment Method upon admission. Those who developed delirium during hospitalization were *** OUTCOME MEASURES： Cause of delirium, wandering, aggression, duration of delirium, physical restraint, use of antipsychotic medicine, recovery from delirium, discharge back home, length of stay, one-to-one nursing care, falls and absconding ***： The 131 age-matched delirious patients comprised 54 males and 77 females. The behavioral disorders of wandering [odds ration （OR） = 2.612, 95% confidence interval （CI） = 1.26 -5.413, P = 0.009] and aggression （OR = 2.243, 95% CI = 1.028 - 4.891, P= 0.04） were more frequent in males than in females. More males received one-to-one nursing care （OR = 4.114, 95% CI = 1.355 - 12.491, P = 0.008）, were more likely to receive antipsychotic medications （OR = 2.24, 95% CI = 1.095-4.583, P = 0.021） and more likely to be physically restrained （OR = 2.07, 95% CI = 1.02-1.02, P = 0.043） compared with female patients. All absconding patients （3/131, 2.3%） were male. In addition, male patients displayed a greater falling rate compared with females （OR = 4.57, 95% CI= 1.519-13.722, P = 0.004）.CONCLUSION： There are gender differences in challenging behaviors, management and outcomes in elde

关键词： delirium challenging behaviors gender difference elderly patients

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Effect of Nalmefene on Delayed Neurocognitive Recovery in elderly patients Undergoing Video-assisted Thoracic Surgery with One Lung Ventilation

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Current Medical Science 2020年第2期40卷 380-388页

作者： Meng-yun LI Chao CHEN Zheng gang WANG Jian-juan KE Xiao-bo FENG Department of Anesthesiology Zhongnan HospitalWuhan UniversiryWuhan 430071China

The intravenous use of nalmefene has been found to exert neuroprotective effect in patients with severe traumatic brain injury and acute cerebral infarction;nonetheless,it is unknown whether nalmefene alleviates delayed neurocognitive *** purpose of the current research was to clarify the impact of nalmefene on delayed neurocognitive recovery in aged patients experiencing video-assisted thoracic surgery(VATS)with intraoperative use of one lung ventilation(OLV).The present study involved 120 paticents undergoing selective VATS,randomized to accept low-dose nalmefene(N1 group,n=40),high-dose nalmefene(N2 group,1n=40)or equal volume of physiologic saline(control group,1=40).A battery of neuropsychological tests were used to estimate cognitive function I day before surgery(o)and 10 days after surgery or before discharge(t).Regional cerebral oxygen saturation(rSO2)was detected 5 min before induction(t),5 min after induction(1),15 and 60 min after onset of OLV(62 and 13),and 15 min after termination of OLV(4).The plasma values of interleukin(IL)-1β,IL-6,tumor necrosis factor(TNF)-a1 and adiponectin(ADP)were also detected prior to induction of anesthesia(T0),1 h,2 h and 6 h after surgery(TI,T2,T3).On 1,delayed neurocognitive recovery occurred in 5/40(12.5%)patients of NI group,in 5/40(12.5%)patients of N2 group and in 13/40(32.5%)patients of control group(PNl group>control group(P<0.05).The result of our present research supports the hypothesis that the perioperative intravenous t

关键词： nalmefene one lung ventilation elderly patients delayed neurocognitive recovery perioperative neurocognitive disorders thoracic surgery

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The prognostic nutritional index on postoperative day one is associated with one-year mortality after burn surgery in elderly patients

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Burns & Trauma 2021年第1期9卷 603-612页

作者： Young Joo Seo Yu-Gyeong Kong Jihion Yu Ji Hyun Park Su-Jin Kim Hee Yeong Kim Young-Kug Kim Department of Anesthesiology and Pain Medicine Hangang Sacred Heart HospitalHallym University College of Medicine12Beodeunaru-ro 7-gilYeongdeungpo-guSeoul 07247Republic of Korea Department of Anesthesiology and Pain Medicine Asan Medical CenterUniversity of Ulsan College of Medicine88Olympic-ro 43-gilSongpa-guSeoul 05505Republic of Korea Department of Anesthesiology and Pain Medicine National Medical Center245EuljiroJung-guSeoul 04564Republic of Korea

Background:Burn injury in elderly patients can result in poor *** nutritional index(PNI)can predict the perioperative nutritional status and postoperative *** aim to evaluate the risk factors,including PNI,for one-year mortality after burn surgery in elderly ***:Burn patients aged≥65 years were retrospectively *** calculated using the following equation:10×serum albumin level(g/dL)+0.005×total lymphocyte count(per mm3).Cox regression,receiver operating characteristic curve and Kaplan–Meier survival analyses were performed to evaluate the risk factors for postoperative one-year ***:Postoperative one-year mortality occurred in 71(37.6%)of the 189 elderly burn *** factors for one-year mortality were PNI on postoperative day one(hazard ratio(HR)=0.872;95%CI=0.812–0.936;ppatients with PNI≤25.5 had a significantly lower one-year survival rate than those with PNI>25.5(32.1%vs 75.9%,pelderly burn *** postoperative one-year survival rate was lower in patients with PNI≤25.5 than in those with PNI>*** findings indicate the importance of identifying elderly burn patients with low PNI,thereby reducing the mortality after burn surgery.

关键词： Burn elderly patients Prognostic nutritional index Mortality Nutrition Geriatric patients

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