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Patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris randomised to an invasive versus conservative strategy: angiographic and procedural results from the After Eighty study.

ABSTRACT: OBJECTIVES:We aimed to report the angiographic and procedural results of the After Eighty study (ClinicalTrials.gov, NCT01255540), and to identify independent predictors of revascularisation. METHODS:Patients of ?80 years old with non-ST-elevation myocardial infarction and unstable angina pectoris were randomised to an invasive or conservative strategy. Angiographic and procedural results were recorded. Univariate and multivariate analyses were performed to explore variables predicting revascularisation. RESULTS:Among 229 patients in the invasive group, 220 underwent immediate coronary angiography (90% performed via the radial artery). Of these patients, 48% had three-vessel disease or left main stenosis, 18% two-vessel disease, 16% one-vessel disease, 17% minor coronary vessel wall changes and two patients had normal coronary arteries. Six patients (3%) underwent coronary artery bypass graft. Percutaneous coronary intervention (PCI) was performed in 107 patients (49%), with 57% treated with bare metal stents, 37% drug-eluting stents and 6% balloon angioplasty. On average, 1.7 lesions were treated and 2 stents delivered per patient. Complications included 1 major PCI-related bleeding (successfully treated), 2 minor access site-related bleedings, 3 side branch occlusions during PCI and 11 periprocedural myocardial infarctions (considered end points). Sex, bundle branch block and smoking were independent predictors of revascularisation. CONCLUSIONS:PCI was performed in approximately half of the patients, similar to findings in younger populations. Procedural success was high, with few complications. TRIAL REGISTRATION NUMBER:NCT01255540.

SUBMITTER: Tegn N

PROVIDER: S-EPMC7380709 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris randomised to an invasive versus conservative strategy: angiographic and procedural results from the After Eighty study.

Tegn Nicolai N Eek Christian C Abdelnoor Michael M Aaberge Lars L Endresen Knut K Skårdal Rita R Berg Erlend Sturle ES Gullestad Lars L Bendz Bjørn B

Open heart 20200701 2

<h4>Objectives</h4>We aimed to report the angiographic and procedural results of the After Eighty study (ClinicalTrials.gov, NCT01255540), and to identify independent predictors of revascularisation.<h4>Methods</h4>Patients of ≥80 years old with non-ST-elevation myocardial infarction and unstable angina pectoris were randomised to an invasive or conservative strategy. Angiographic and procedural results were recorded. Univariate and multivariate analyses were performed to explore variables predi ...[more]

PMID: 32719073

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Project description:ObjectivesThis study aimed to ascertain if the radiomics features of epicardial adipose tissue (EAT) and pericoronary adipose tissue (PCAT) based on coronary computed tomography angiography (CCTA) could identify non-ST-segment elevation myocardial infarction (NSTEMI) from unstable angina (UA).Materials and methodsThis retrospective case-control study included 108 patients with NSTEMI and 108 controls with UA. All patients were separated into training cohort (n = 116), internal validation cohort 1 (n = 50), and internal validation cohort 2 (n = 50) based on the time order of admission. The internal validation cohort 1 used the same scanner and scan parameters as the training cohort, while the internal validation cohort 2 used different canners and scan parameters than the training cohort. The EAT and PCAT radiomics features selected by maximum relevance minimum redundancy (mRMR) and least absolute shrinkage and selection operator (LASSO) were adopted to build logistic regression models. Finally, we developed an EAT radiomics model, three vessel-based (right coronary artery [RCA], left anterior descending artery [LAD], and left circumflex artery [LCX]) PCAT radiomics models, and a combined model by combining the three PCAT radiomics models. Discrimination, calibration, and clinical application were employed to assess the performance of all models.ResultsEight radiomics features of EAT, sixteen of RCA-PCAT, fifteen of LAD-PCAT, and eighteen of LCX-PCAT were selected and used to construct radiomics models. The area under the curves (AUCs) of the EAT, RCA-PCAT, LAD-PCAT, LCX-PCAT and the combined models were 0.708 (95% CI: 0.614-0.802), 0.833 (95% CI:0.759-0.906), 0.720 (95% CI:0.628-0.813), 0.713 (95% CI:0.619-0.807), 0.889 (95% CI:0.832-0.946) in the training cohort, 0.693 (95% CI:0.546-0.840), 0.837 (95% CI: 0.729-0.945), 0.766 (95% CI: 0.625-0.907), 0.675 (95% CI: 0.521-0.829), 0.898 (95% CI: 0.802-0.993) in the internal validation cohort 1, and 0.691 (0.535-0.847), 0.822 (0.701-0.944), 0.760 (0.621-0.899), 0.674 (0.517-0.830), 0.866 (0.769-0.963) in the internal validation cohort 2, respectively.ConclusionCompared with the RCA-PCAT radiomics model, the EAT radiomics model had a limited ability to discriminate between NSTEMI and UA. The combination of the three vessel-based PCAT radiomics may have the potential to distinguish between NSTEMI and UA.

Project description:Objective: Dazhu hongjingtian [DZHJT, Rhodiola wallichiana var. cholaensis (Praeger) S.H. Fu] preparation as an add-on therapy has been applied to the treatment of angina pectoris. We aimed to evaluate the efficacy and safety of DZHJT as adjuvant therapy for the treatment of unstable angina pectoris (UAP). Methods: An extensive literature search was conducted on PubMed, Emase, Cochrane Library, Wanfang, CNKI, and VIP databases from inception to January 2019. Randomized controlled trials (RCTs) comparing DZHJT in combination with Western medicine with Western medicine alone were included. Two authors independently performed the literature search, data extraction and risk of bias assessment of included studies, and conducted the statistical analysis. Results: A total of 18 RCTs involving 1,679 patients were included in the meta-analysis. Adjuvant treatment with DZHJT significantly decreased ?80% reduction in the frequency of angina attacks [risk ratio (RR) 1.57; 95% CI 1.36-1.81], weekly frequency of angina attacks [mean difference (MD) -1.03 times; 95% confidence interval (CI) -1.51 to -0.55], marked improved abnormal electrocardiogram (RR 1.46; 95% CI 1.23-1.74). In addition, DZHJT significantly reduced the whole-blood viscosity (MD -0.70 mPa.s; 95% CI -0.84 to -0.55), plasma viscosity (MD -0.28 mPa.s; 95% CI -0.38 to -0.19), serum level of fibrinogen (MD -0.67 g/L; 95% CI -0.79 to -0.54), thromboxanes B2 (MD -14.01 ng/L; 95% CI -20.86 to -7.15), and C-reactive protein (MD -1.48 mg/L; 95% CI -2.72 to -0.25). No significant differences in headache/dizziness (RR 0.72; 95% CI 0.31-1.67) were observed between two groups. Conclusion: Adjuvant treatment with DZHJT has an add-on effect in reducing angina pectoris attacks in patients with UAP. The beneficial effect may be correlated with regulating whole-blood viscosity, plasma viscosity, fibrinogen, thromboxanes B2, and CRP level. However, future well-designed prospective, randomized, double-blind placebo-controlled trials with large sample sizes are required to evaluate the evidence.

Dataset Information

Patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris randomised to an invasive versus conservative strategy: angiographic and procedural results from the After Eighty study.

Publications

Patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris randomised to an invasive versus conservative strategy: angiographic and procedural results from the After Eighty study.

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