International variation in invasive care of the elderly with acute coronary syndromes.


AIMS:To explore variations in invasive care of the elderly with acute coronary syndromes across international practice. METHODS AND RESULTS:Using combined populations from the SYMPHONY and 2nd SYMPHONY trials, we describe 30-day cardiac catheterization in elderly (> or = 75 years; n = 1794) vs. younger patients (< 75 years; n = 14,043) after multivariable adjustment and by region of enrolment. The use of cardiac catheterization and revascularization were not protocol-specified. Elderly patients (median age 78 years) were more often female and more frequently had hypertension, diabetes, prior myocardial infarction, and prior coronary bypass surgery. Overall, they underwent less cardiac catheterization than younger patients [53 vs. 63%; adjusted OR 0.53 (0.46, 0.60)]. The absolute rate of cardiac catheterization in the elderly varied from 77% (vs. 91% in younger patients) in the US cohort to 27% (vs. 41% in younger patients) in the non-US cohort. Revascularization of elderly who underwent cardiac catheterization was also higher in US than non-US cohorts (71.3 vs. 53.6%). There was a significant interaction between the patient age and the use of catheterization across US and non-US regions of enrolment, as well as differences in the predictors of catheterization in the elderly. Despite these findings, after adjustment, 90-day rates of death and death or myocardial infarction (MI) were not significantly different in elderly who underwent catheterization compared with those who did not. CONCLUSION:Although older age is universally predictive of lower use of cardiac catheterization, marked variation in catheterization of the elderly exists across international practice. Demonstrated differences in patterns of use suggest a lack of consensus regarding optimal use of an invasive strategy in the elderly.


Eur Heart J


European heart journal


Alexander KP,Newby LK,Bhapkar MV,White HD,Hochman JS,Pfisterer ME,Moliterno DJ,Peterson ED,Van de Werf F,Armstrong PW,Califf RM,Symphony and 2nd Symphony Investigators.




Has Abstract


2006-07-01 00:00:00














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    journal_title:European heart journal

    pub_type: 杂志文章,多中心研究


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    更新日期:2011-12-01 00:00:00

  • Sudden death from pulmonary thromboembolism: chronobiological aspects.

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    journal_title:European heart journal

    pub_type: 杂志文章,评审


    authors: Gallerani M,Manfredini R,Ricci L,Grandi E,Cappato R,Calò G,Pareschi PL,Fersini C

    更新日期:1992-05-01 00:00:00

  • Quantitative analysis of the signal-averaged QRS in patients with arrhythmogenic right ventricular dysplasia.

    abstract::Temporal signal averaging of the surface QRS (V1 + V3 + V5) was performed in 16 patients with arrhythmogenic right ventricular dysplasia and in 16 normal subjects. The differences between ARVD patients and normals were large for the filtered QRS duration (FQRSd) (146.2 +/- 18.9 ms vs. 91.8 +/- 4.1 ms, P less than 0.00...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Blomström-Lundqvist C,Hirsch I,Olsson SB,Edvardsson N

    更新日期:1988-03-01 00:00:00

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    abstract:AIMS:The aim of the study was to evaluate the long-term results of allograft and prosthetic valve replacement in the treatment of infective aortic valve endocarditis with periannular abscess. METHODS:Between March 1988 and March 1996, 65 patients underwent surgery for active aortic valve endocarditis and paravalvular ...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Knosalla C,Weng Y,Yankah AC,Siniawski H,Hofmeister J,Hammerschmidt R,Loebe M,Hetzer R

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    journal_title:European heart journal

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Schofer J,Hobuss M,Aschenberg W,Tews A

    更新日期:1990-08-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章


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    更新日期:2018-05-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Gaudron P,Eilles C,Ertl G,Kochsiek K

    更新日期:1990-04-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章,评审


    authors: Erne P,Conen D,Kiowski W,Bolli P,Müller FB,Bühler FR

    更新日期:1987-11-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章,评审


    authors: Peters R,Beckett N,McCormack T,Fagard R,Fletcher A,Bulpitt C

    更新日期:2014-07-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Nelson GI,Ahuja RC,Silke B,Okoli RC,Hussain M,Taylor SH

    更新日期:1983-10-01 00:00:00

  • Deceptive surgical results in three siblings with familial Wolff-Parkinson-White syndrome.

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Patruno N,Coltorti F,Pulignano G,Urbani P,Critelli G

    更新日期:1990-12-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章,多中心研究,随机对照试验


    authors: Smith LA,Vennelle M,Gardner RS,McDonagh TA,Denvir MA,Douglas NJ,Newby DE

    更新日期:2007-05-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章



    更新日期:1988-02-01 00:00:00

  • Haemodynamic effects of enalaprilat and preload in acute severe heart failure complicating myocardial infarction.

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Tohmo H,Karanko M,Korpilahti K

    更新日期:1994-04-01 00:00:00

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    更新日期:2009-09-01 00:00:00

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    abstract::Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the ava...

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    pub_type: 杂志文章


    authors: Pristipino C,Germonpré P,Toni D,Sievert H,Meier B,D'Ascenzo F,Berti S,Onorato EM,Bedogni F,Mas JL,Scacciatella P,Hildick-Smith D,Gaita F,Kyrle PA,Thomson J,Derumeaux G,Sibbing D,Chessa M,Hornung M,Zamorano J,Dudek

    更新日期:2021-01-28 00:00:00

  • Noninvasive estimation of systolic pressure in the right ventricle in patients with tricuspid regurgitation.

    abstract::In 70 patients, tricuspid regurgitation was diagnosed with Doppler by recording reverse flow in systole originating at the tricuspid orifice, directed into the right atrium. The peak velocities were recorded, and the peak pressure drop from the right ventricle to the right atrium in systole was calculated from the sim...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Skjaerpe T,Hatle L

    更新日期:1986-08-01 00:00:00

  • Radioiodinated beta-methyl phenyl fatty acids as potential tracers for myocardial imaging and metabolism.

    abstract::Since fatty acids provide the majority of myocardial energy requirements under basal conditions, an alteration in the global or regional utilization of these substrates may be an early indicator of myocardial disease. To determine areas of potential clinical utility of fatty acid imaging, we synthesized a radioiodinat...

    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Livni E,Elmaleh DR,Barlai-Kovach MM,Goodman MM,Knapp FF Jr,Strauss HW

    更新日期:1985-08-01 00:00:00

  • DNA testing for hypertrophic cardiomyopathy: a cost-effectiveness model.

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    journal_title:European heart journal

    pub_type: 杂志文章,评审


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    更新日期:2010-04-01 00:00:00

  • Sustained-release diltiazem versus metoprolol in stable angina pectoris.

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    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Posma JL,van Dijk RB,Lie KI

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  • Prospective cohort study of C-reactive protein as a predictor of clinical events in adults with congenital heart disease: results of the Boston adult congenital heart disease biobank.

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    journal_title:European heart journal

    pub_type: 杂志文章


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    journal_title:European heart journal

    pub_type: 杂志文章


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  • The Anglo-Scandinavian Cardiac Outcomes Trial: 11-year mortality follow-up of the lipid-lowering arm in the U.K.

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    journal_title:European heart journal

    pub_type: 杂志文章,多中心研究,随机对照试验


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    更新日期:2011-10-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Scognamiglio R,Fasoli G,Bruni A,Dalla-Volta S

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Anversa P,Reiss K,Kajstura J,Cheng W,Li P,Sonnenblick EH,Olivetti G

    更新日期:1995-12-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Hasper D,Hummel M,Kleber FX,Reindl I,Volk HD

    更新日期:1998-05-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Malfatto G,Pessano P,Zaza A,Schwartz PJ

    更新日期:1993-09-01 00:00:00

  • Intravascular ultrasound evaluation after sirolimus eluting stent implantation for de novo and in-stent restenosis lesions.

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    journal_title:European heart journal

    pub_type: 杂志文章


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    更新日期:2004-01-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Svatikova A,Wolk R,Magera MJ,Shamsuzzaman AS,Phillips BG,Somers VK

    更新日期:2004-08-01 00:00:00

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    journal_title:European heart journal

    pub_type: 杂志文章


    authors: Pankuweit S,Lottspeich F,Maisch B

    更新日期:1995-12-01 00:00:00