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RevascularizationinComplexPatientSubsets
Theveryelderly()
ComplexCADanddiabetes()
Chronickidneydisease()
PoorLVfunction()
Vascularcomplicationsandwomen()
Revascularization InTheVeryElderly
,.,.
WilliamBeaumontHospital
RoyalOak,Michigan,.
In-HospitalComplicationsAfterPCI: EffectofAge
Bachelor,JACC2000;36:723
Complications*AfterElectivePCI inOctogenarians
Death
MI
Q-wave
Stroke
Death/MI/
CVA
Renal
failure
Vascular
complications
;36:723
*p<.001forallcomplications
*
*
*
*
*
*
SafetyConcernsinACSCare: TheElderlyBleedMore
YangetalJAmCollCardiol2005;46:1490-5
0
5
10
15
20
<55
55-64
65-74
≥75
Agegroup(years)
BloodTransfusion(%)
<55
55-64
65-74
≥75
Agegroup(years)
#ofAnti-platelet/coagulantsUsed*
1AgentUsed
2AgentsUsed
≥3AgentsUsed
*Aspirin,Clopidogrel,UFH,LMWH,GPIIb/IIIaInhibitor
AcuteCoronarySyndromeRegistries
Elderlypatients
Vaguesymptoms
Moreco-morbidities
Lesslikelytoreceivemedicaltreatmentsofprovenbenefit
Lesslikelytoreceivecathorrevascularization
Worseoutcomes
PRAIS-UK,AgeandAging2005;34:61-66
CRUSADE,JAMA2004;292:2096-104
GRACE,AmHeartJ2005;149:67-73
TACTICS-TIMI18:ElderlyACSPatientsBenefittheMostFromEarlyInvasiveStrategy
AnnInternMed2004;141:186-195
AMIintheElderly
Advancedagestrongestdeterminantofearlyandlatemortality
80%ofalldeathsareinpatients>60yearsold
riskofintracranialbleeding
Minorityreceivelytictherapy(10%ofpatients>65yearsold)
<75yrs(n=2580)
75yrs(n=452)
p<.001
p=.01
p<.001
p<.001
p<.001
p<.001
;86:30
PCIrestoredTIMI3flowin92%ofyoung,85%ofelderly(p=.001)
OutcomeofPAMIPatientsBasedonAge