scholarly journals Bleeding risk assessment and comorbidities in elderly patients with acute coronary syndromes

2016 ◽  
Vol 35 (4) ◽  
pp. 247-248
Author(s):  
Albert Ariza-Solé ◽  
Francesc Formiga ◽  
Eva Bernal ◽  
Alberto Garay
Keyword(s):  
Risk Assessment ◽  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Bleeding Risk ◽  
Coronary Syndromes

Global Geriatric Assessment and In-Hospital Bleeding Risk in Elderly Patients with Acute Coronary Syndromes: Insights from the LONGEVO-SCA Registry

2018 ◽  
Vol 118 (03) ◽  
pp. 581-590 ◽  
Author(s):  
Albert Ariza-Solé ◽  
Carme Guerrero ◽  
Francesc Formiga ◽  
Jaime Aboal ◽  
Emad Abu-Assi ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Geriatric Assessment ◽  
Major Bleeding ◽  
Acute Coronary Syndromes ◽  
Short Form ◽  
Bleeding Risk ◽  
Cognitive Status ◽  
Charlson Index ◽  
Nutritional Risk ◽  
Coronary Syndromes

Background Bleeding risk scores have shown a limited predictive ability in elderly patients with acute coronary syndromes (ACS). No study explored the role of a comprehensive geriatric assessment to predict in-hospital bleeding in this clinical setting. Methods The prospective multicentre LONGEVO-SCA registry included 532 unselected patients with non-ST segment elevation ACS (NSTEACS) aged 80 years or older. Comorbidity (Charlson index), frailty (FRAIL scale), disability (Barthel index and Lawton–Brody index), cognitive status (Pfeiffer test) and nutritional risk (mini nutritional assessment-short form test) were assessed during hospitalization. CRUSADE score was prospectively calculated for each patient. In-hospital major bleeding was defined by the CRUSADE classification. The association between geriatric syndromes and in-hospital major bleeding was assessed by logistic regression method and the area under the receiver operating characteristic curves (AUC). Results Mean age was 84.3 years (SD 4.1), 61.7% male. Most patients had increased troponin levels (84%). Mean CRUSADE bleeding score was 41 (SD 13). A total of 416 patients (78%) underwent an invasive strategy, and major bleeding was observed in 37 cases (7%). The ability of the CRUSADE score for predicting major bleeding was modest (AUC 0.64). From all aging-related variables, only comorbidity (Charlson index) was independently associated with major bleeding (per point, odds ratio: 1.23, p = 0.021). The addition of comorbidity to CRUSADE score slightly improved the ability for predicting major bleeding (AUC: 0.68). Conclusion Comorbidity was associated with major bleeding in very elderly patients with NSTEACS. The contribution of frailty, disability or nutritional risk for predicting in-hospital major bleeding was marginal.

Efficacy of Bleeding Risk Scores in Elderly Patients with Acute Coronary Syndromes

2014 ◽  
Vol 67 (6) ◽  
pp. 463-470 ◽  
Author(s):  
Albert Ariza-Solé ◽  
Francesc Formiga ◽  
Victoria Lorente ◽  
José C. Sánchez-Salado ◽  
Guillermo Sánchez-Elvira ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Bleeding Risk ◽  
Risk Scores ◽  
Coronary Syndromes

Is there Sex-related Outcome Difference According to oral P2Y12 Inhibitors in Patients with Acute Coronary Syndromes? A Systematic Review and Meta-Analysis of 107,126 Patients

2019 ◽  
Vol 17 (2) ◽  
pp. 191-203
Author(s):  
Oliver Brown ◽  
Jennifer Rossington ◽  
Gill Louise Buchanan ◽  
Giuseppe Patti ◽  
Angela Hoye
Keyword(s):  
Systematic Review ◽  
Acute Coronary Syndromes ◽  
Meta Analysis ◽  
Indirect Comparison ◽  
Bleeding Risk ◽  
Cardiovascular Death ◽  
P2y12 Inhibitors ◽  
Significant Difference ◽  
Coronary Syndromes ◽  
Randomised Controlled

Background and Objectives: The majority of patients included in trials of anti-platelet therapy are male. This systematic review and meta-analysis aimed to determine whether, in addition to aspirin, P2Y12 blockade is beneficial in both women and men with acute coronary syndromes. </P><P> Methods: Electronic databases were searched and nine eligible randomised controlled studies were identified that had sex-specific clinical outcomes (n=107,126 patients). Risk Ratios (RR) and 95% Confidence Intervals (CI) were calculated for a composite of cardiovascular death, myocardial infarction or stroke (MACE), and a safety endpoint of major bleeding for each sex. Indirect comparison analysis was performed to statistically compare ticagrelor against prasugrel. </P><P> Results: Compared to aspirin alone, clopidogrel reduced MACE in men (RR, 0.79; 95% CI, 0.68 to 0.92; p=0.003), but was not statistically significant in women (RR, 0.88; 95% CI, 0.75 to 1.02, p=0.08). Clopidogrel therapy significantly increased bleeding in women but not men. Compared to clopidogrel, prasugrel was beneficial in men (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02) but not statistically significant in women (RR, 0.94; 95% CI, 0.83 to 1.06; p=0.30); ticagrelor reduced MACE in both men (RR, 0.85; 95% CI, 0.77 to 0.94; p=0.001) and women (RR, 0.84; 95% CI, 0.73 to 0.97; p=0.02). Indirect comparison demonstrated no significant difference between ticagrelor and prasugrel in either sex. Compared to clopidogrel, ticagrelor and prasugrel increased bleeding risk in both women and men. </P><P> Conclusion: In summary, in comparison to monotherapy with aspirin, P2Y12 inhibitors reduce MACE in women and men. Ticagrelor was shown to be superior to clopidogrel in both sexes. Prasugrel showed a statistically significant benefit only in men; however indirect comparison did not demonstrate superiority of ticagrelor over prasugrel in women.

Impact of frailty and atrial fibrillation in elderly patients with acute coronary syndromes

2021 ◽  
Vol 51 (5) ◽  
Author(s):  
María Asunción Esteve‐Pastor ◽  
Ernesto Martín ◽  
Oriol Alegre ◽  
Francesc Formiga ◽  
Juan Sanchís ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Elderly Patients ◽  
Acute Coronary Syndromes ◽  
Coronary Syndromes
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