Abstract:
AIMS:Older people increasingly constitute a large proportion of the acute coronary syndrome (ACS) population. We examined the relationship of age with receipt of more intensive management and secondary prevention medicine. Then, the comparative association of intensive management (reperfusion/angiography) over a conservative strategy on time to death was investigated by age. METHODS AND RESULTS:Using data from 155 818 patients in the national registry for ACS in England and Wales [the Myocardial Ischaemia National Audit Project (MINAP)], we found that older patients were incrementally less likely to receive secondary prevention medicines and intensive management for both ST-elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI). In STEMI patients ≥85 years, 55% received reperfusion compared with 84% in those aged 18 to <65 [odds ratio 0.22 (95% CI 0.21, 0.24)]. Not receiving intensive management was associated with worse survival [mean follow-up 2.29 years (SD 1.42)] in all age groups (adjusted for sex, cardiovascular risk factors, co-morbidities, healthcare factors, and case severity), but there was an incremental reduction in survival benefit from intensive management with increasing age. In STEMI patients aged 18-64, 65-74, 75-84, and ≥85, adjusted hazard ratios (HRs) for all-cause mortality comparing conservative treatment to intensive management were 1.98 (1.78, 2.19), 1.65 (1.51, 1.80), 1.62 (1.52, 1.72), and 1.36 (1.27, 1.47), respectively. In NSTEMI patients, the respective HRs were 4.37 (4.00, 4.78), 3.76 (3.54, 3.99), 2.79 (2.67, 2.91), and 1.90 (1.77, 2.04). CONCLUSION:We found an incremental reduction in the use of evidence-based therapies with increasing age using a national ACS registry cohort. While survival benefit from more intensive management reduced with older age, better survival was associated with intensive management at all ages highlighting the requirement to improve standard of care in older patients with ACS.
journal_name
Eur Heart Jjournal_title
European heart journalauthors
Zaman MJ,Stirling S,Shepstone L,Ryding A,Flather M,Bachmann M,Myint PKdoi
10.1093/eurheartj/ehu039subject
Has Abstractpub_date
2014-06-14 00:00:00pages
1551-8issue
23eissn
0195-668Xissn
1522-9645pii
ehu039journal_volume
35pub_type
杂志文章abstract::An exercise test was performed in 455 patients in the third week after acute myocardial infarction (AMI). One hundred and seventeen (26%) of them were considered as having a complicated AMI. During a follow-up of 4.5 years their mortality was 49% vs 23% in the remaining patients with uncomplicated AMI. The survival of...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a062329
更新日期:1987-06-01 00:00:00
abstract:AIMS:The obesity paradox refers to the epidemiological evidence that obesity compared with normal weight is associated with counter-intuitive improved health in a variety of disease conditions. The aim of this study was to investigate the relationship between body mass index (BMI) and mortality in patients with acute c...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehs217
更新日期:2013-02-01 00:00:00
abstract:AIMS:The choice of resynchronization therapy between with (CRT-D) and without (CRT-P) a defibrillator remains a contentious issue. Cause-of-death analysis among CRT-P, compared with CRT-D, patients could help evaluate the extent to which CRT-P patients would have additionally benefited from a defibrillator in a daily c...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/ehv455
更新日期:2015-11-01 00:00:00
abstract:AIMS:To evaluate the effects of simvastatin only or combined with continuous hormone replacement therapy on the serum lipid profile in hypercholesterolaemic post-menopausal women. METHODS AND RESULTS:One hundred hypercholesterolaemic post-menopausal women were given either simvastatin 10 mg daily together with oestrog...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.1999.1582
更新日期:2000-02-01 00:00:00
abstract:AIM:To compare patients treated for heart failure in relation to the management in general practices versus hospital admission. METHODS AND RESULTS:Twelve randomly selected general practices (GP) were screened for patients receiving ACE-inhibitor, digoxin, or loop diuretic treatment. The first 500 volunteers of 959 po...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ehj.2004.06.033
更新日期:2004-10-01 00:00:00
abstract::During a 3-year period 2500 asymptomatic male aviators were screened routinely for coronary artery disease by maximal bicycle exercise testing. In 55 cases (2.1%) the exercise ECG was abnormal (40 subjects exhibited ST depression, 14 ventricular ectopic activity and in one subject both abnormalities were observed). Fu...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/12.7.766
更新日期:1991-07-01 00:00:00
abstract:BACKGROUND:Polymorphisms within renin angiotensin system genes have been investigated as risk factors for coronary artery disease in different populations with contradicting results. The aim of this study was to investigate the genotype distribution and the allele frequencies of ACE, AT1R and AGT gene polymorphisms as ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1053/euhj.1999.1738
更新日期:2000-04-01 00:00:00
abstract::We have determined the effects of the acute administration of intravenous (i.v.) digitalis administration (0.8 mg of digoxin in 5-10 min) on the electrophysiological variables of 12 normal subjects (group 1), 12 patients with asymptomatic sinus node bradycardia (group 2) and 34 patients with symptomatic sinus node dys...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a062071
更新日期:1986-04-01 00:00:00
abstract:AIMS:The SHould we emergently revascularize Occluded Coronaries in cardiogenic shocK (SHOCK) Trial showed no benefit of early revascularization in patients aged >/=75 years with acute myocardial infarction and cardiogenic shock. We examined the effect of age on treatment and outcomes of patients with cardiogenic shock ...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0195-668x(02)00844-8
更新日期:2003-05-01 00:00:00
abstract:AIMS:To evaluate the effect of thrombolysis on mortality and its causes in older patients with acute myocardial infarction (AMI). METHODS AND RESULTS:An analysis of 706 consecutive patients > or =75 years old with a first AMI enrolled in the PPRIMM75 registry showed that although there were important differences in ba...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehi284
更新日期:2005-09-01 00:00:00
abstract::The early termination of clinical trials, for either benefit or harm, often generates undue enthusiasm or alarm. The enhanced publicity attending early termination of a trial promotes inappropriate interpretations because of the inherent difficulty of a prompt and comprehensive data review. Furthermore, the process of...
journal_title:European heart journal
pub_type: 杂志文章
doi:
更新日期:1994-06-01 00:00:00
abstract:BACKGROUND:The economic evaluation of the results of the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Artery (GUSTO) trial found that recombinant tissue plasminogen activator is more cost-effective than streptokinase for the treatment of acute myocardial infarction. AIM:We...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1053/euhj.1998.1092
更新日期:1998-10-01 00:00:00
abstract::There has been considerable controversy over whether elevated levels of triglycerides, or hypertriglyceridaemia, is an independent risk factor in coronary heart disease (CHD). Discrepancies between findings of univariate and multivariate statistical analyses are likely to be due to the strong inverse correlation betwe...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:
更新日期:1998-07-01 00:00:00
abstract::Contrary to most prospective epidemiologic studies, an earlier report from the British Regional Heart Study (BRHS) suggested that high density lipoprotein (HDL)-cholesterol in men aged 40-59 years was not a significant, independent, predictive risk factor for coronary heart disease (CHD), controlling for the composite...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/11.suppl_h.21
更新日期:1990-12-01 00:00:00
abstract::Clonidine administration by i.v. infusion in 12 patients with hypertension emergencies (diastolic blood pressure over 130 mmHg) resulted in the normalization of blood pressure (BP) in all patients. Lowering of BP was associated with a reduction in total and lower limb vascular resistance. Heart rate showed a slight an...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a061605
更新日期:1984-12-01 00:00:00
abstract::Priorities for unanswered questions concerning major areas of cardiovascular disease are being sought by the British Cardiovascular Society, using the methods of the James Lind Alliance, which involves clinicians and patients in an equal partnership, reports Barry Shurlock PhD. ...
journal_title:European heart journal
pub_type: 新闻
doi:
更新日期:2015-06-01 00:00:00
abstract::Angiotensin-converting enzyme inhibitors suppress plasma concentrations of the sodium retaining hormones angiotensin II and aldosterone. This action should potentiate the natriuretic and diuretic effects of loop diuretics. Some studies indicate, however, that the introduction of angiotensin-converting enzyme inhibitor...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/12.8.924
更新日期:1991-08-01 00:00:00
abstract:AIM:To examine the association of left ventricular hypertrophy (LVH) on admission electrocardiography with adverse outcomes in acute coronary syndrome (ACS) patients. METHODS AND RESULTS:A total of 7443 non-ST-elevation ACS patients in Global Utilization of STrategies to Open occluded arteries (GUSTO) IV ACS trial had...
journal_title:European heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1093/eurheartj/ehm223
更新日期:2007-09-01 00:00:00
abstract:AIMS:Obstructive sleep apnoea (OSA) is highly prevalent in patients with chronic heart failure (CHF) and may contribute to CHF progression. We aimed to determine whether treatment of OSA with continuous positive airway pressure (CPAP) would improve subjective and objective measures of heart failure severity in patients...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1093/eurheartj/ehm131
更新日期:2007-05-01 00:00:00
abstract::This report describes a patient with left atrial ball thrombus which was detected during echocardiographic evaluation of combined mitral-aortic valve disease. Surgical correction was performed entirely on the basis of the echocardiographic diagnosis. ...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060161
更新日期:1992-02-01 00:00:00
abstract:AIMS :In the last decade, transcatheter aortic valve (TAV) replacement determined a paradigm shift in the treatment of patients with severe symptomatic aortic stenosis. Data on long-term TAV performance are still limited. We sought to evaluate the clinical and haemodynamic outcomes of the CoreValve self-expandable valv...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehz925
更新日期:2020-05-21 00:00:00
abstract::Forty patients with prosthetic valve endocarditis (PVE) presenting during a 12-year period at a single hospital were studied. Twenty-six were male and 14 female and ages ranged from 19 to 67 years. During the first six post-operative months, most episodes were caused by staphylococci (38%) and Gram negative bacilli (2...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/5.suppl_c.133
更新日期:1984-10-01 00:00:00
abstract::We performed echocardiographic evaluation of 20 male veteran endurance runners (mean age 56 +/- 7 years) and compared them with a group of age-matched controls. All the runners had run at least 25 miles per week for more than 25 years. Although only four athletes showed voltage ECG evidence of left ventricular hypertr...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a059585
更新日期:1990-01-01 00:00:00
abstract:AIMS:To document tracking patterns, if any, over time, of classical cardiovascular risk factors in men and women participants in the Vorarlberg Health Monitoring and Promotion Programme (VHM&PP) METHODS AND RESULTS: 67,413 men and 82,237 women underwent a total of 45,4448 standardised examinations in the 15 year period...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1016/s0195-668x(03)00170-2
更新日期:2003-06-01 00:00:00
abstract::Considerable effort and large sums of money have been spent on constructing a risk profile for sudden death in the myocardial infarction survivor at the time of discharge from hospital. However, these patients are only a minority among those dying suddenly outside hospital. The majority of sudden death victims cannot ...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:10.1093/eurheartj/16.suppl_g.7
更新日期:1995-08-01 00:00:00
abstract:AIMS:Kinetics of recovery oxygen consumption after exercise plays an important role in determining exercise capacity. This study was performed to assess the kinetics of recovery oxygen consumption in mitral stenosis and evaluate the effects of percutaneous balloon mitral valvuloplasty and exercise training on the kinet...
journal_title:European heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1053/euhj.1998.1146
更新日期:1998-12-01 00:00:00
abstract::Transesophageal echocardiographic evaluation of right and left pulmonary arteries, up to the origin of their lobar branches, was prospectively performed with a single plane probe in 32 consecutive patients (18 M, 14 F, aged 55.5 +/- 14.6, from 32 to 80 years) with clinical or echocardiographic suspicion of pulmonary e...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/oxfordjournals.eurheartj.a060947
更新日期:1995-04-01 00:00:00
abstract:AIMS:Diastolic dysfunction in acute myocardial infarction (MI) is associated with adverse outcome. Recently, the ratio of early mitral inflow velocity (E) to global diastolic strain rate (e'sr) has been proposed as a marker of elevated LV filling pressure. However, the prognostic value of this measure has not been demo...
journal_title:European heart journal
pub_type: 杂志文章,多中心研究
doi:10.1093/eurheartj/eht179
更新日期:2014-03-01 00:00:00
abstract:Aims:The burden of cardiovascular disease is increasing worldwide, which has to be reflected by cardiovascular (CV) research in Europe. CardioScape, a FP7 funded project initiated by the European Society of Cardiology (ESC), identified where CV research is performed, how it is funded and by whom. It could be transforme...
journal_title:European heart journal
pub_type: 杂志文章
doi:10.1093/eurheartj/ehx106
更新日期:2018-07-01 00:00:00
abstract::Left ventricular pressure overload results in the development of left ventricular hypertrophy (LVH) which is considered an adaptive mechanism of the heart to normalize systolic wall-stress. Impairment of both contractility and relaxation occurs, implying that the hypertrophied myocardium is very sensitive to ischaemia...
journal_title:European heart journal
pub_type: 杂志文章,评审
doi:
更新日期:1993-11-01 00:00:00