Influencia de las comorbilidades en la decisión del tratamiento invasivo en ancianos con SCASEST

  1. Vicente Pernias Escrig 1
  2. José María García Acuña 2
  3. Sergio Raposeiras Roubín 3
  4. José A. Barrabés 4
  5. Alberto Jesús Cordero Díaz 5
  6. Manuel Martínez-Sellés 6
  7. Alfredo Bardají Ruiz 7
  8. P. Díez Villanueva 8
  9. Francisco Marín 9
  10. Juan M. Ruiz-Nodar 10
  11. Nuria Vicente Ibarra 11
  12. Gonzalo Luis Alonso Salinas 12
  13. Pedro Rigueiro Veloso 2
  14. Emad Abu Assi 2
  15. Francesc Formiga Pérez 13
  16. Julio Núñez Feltrer 1
  17. Eduardo Núñez 1
  18. Albert Ariza Solé 14
  19. J.M. Sanchís García 1
  1. 1 Servicio de Cardiología, Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, Valencia, España
  2. 2 Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
  3. 3 Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, España
  4. 4 Servicio de Cardiología, Hospital Universitario Vall d’Hebron, Universidad Autónoma de Barcelona, Barcelona, España
  5. 5 Servicio de Cardiología, Hospital Clínico Universitario de San Juan, San Juan de Alicante, Alicante, España
  6. 6 Servicio de Cardiología, Hospital Universitario Gregorio Marañón, Universidad Complutense, Universidad Europea, Madrid, España
  7. 7 Servicio de Cardiología, Hospital Universitario de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, España
  8. 8 Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, España
  9. 9 Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, IMIB-Arrixaca, El Palmar, Murcia, España
  10. 10 Servicio de Cardiología, Hospital General Universitario de Alicante, Alicante, España
  11. 11 Servicio de Cardiología, Hospital General de Elche, Elche, Alicante, España
  12. 12 Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Madrid, España
  13. 13 Servicio de Medicina Interna, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
  14. 14 Servicio de Cardiología, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, España
Mostrar afiliaciones +
Revista:
REC: Interventional Cardiology

ISSN: 2604-7276,  2604-7306

Año de publicación: 2021

Volumen: 3

Número: 1

Páginas: 15-20

Tipo: Artículo

DOI: 10.24875/RECIC.M20000141 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

Otras publicaciones en: REC: Interventional Cardiology

Resumen

Introducción y objetivos: La comorbilidad en ancianos con síndrome coronario agudo sin elevación del segmento ST empeora el pronóstico. El objetivo fue analizar la influencia de la carga de comorbilidad en la decisión del tratamiento invasivo en ancianos con SCASEST. Métodos: Se incluyeron 7.211 pacientes mayores de 70 años procedentes de 11 registros españoles. Los datos se analizaron en una base de datos conjunta. Se evaluó la presencia de 6 enfermedades simultáneas y su asociación con la realización de coronariografía durante el ingreso. Resultados: La edad media fue de 79 ± 6 años y la puntuación GRACE media fue de 150 ± 21 puntos. Fueron tratados de manera conservadora 1.179 pacientes (16%). La presencia de cada enfermedad se asoció con un menor abordaje invasivo (ajustado por variables clínicas predictivas): enfermedad cerebrovascular (odds ratio [OR] = 0,78; intervalo de confianza del 95% [IC95%], 0,64-0,95; p = 0,01), anemia (OR = 0,64; IC95%, 0,54-0,76; p < 0,0001), insuficiencia renal (OR = 0,65; IC95%, 0,56-0,75; p < 0,0001), arteriopatía periférica (OR = 0,79; IC95%, 0,65-0,96; p = 0,02), enfermedad pulmonar crónica (OR = 0,85; IC95%, 0,71-0,99; p = 0,05) y diabetes mellitus (OR = 0,85; IC95%, 0,74-0,98; p = 0,03). Asimismo, el aumento del número de enfermedades (carga de comorbilidad) se asoció con menor realización de coronariografías, ajustado por la escala GRACE: 1 enfermedad (OR = 0,66; IC95%, 0,54-0,81); 2 (OR = 0,55; IC95%, 0,45-0,69); 3 (OR = 0,37; IC95%, 0,29-0,47); 4 (OR = 0,33; IC95%, 0,24-0,45); ≥ 5 (OR = 0,21; IC95%, 0,12-0,36); todos p < 0,0001, en comparación con ninguna enfermedad. Conclusiones: Conforme aumenta la comorbilidad disminuye la realización de coronariografías en ancianos con síndrome coronario agudo sin elevación del segmento ST. Se necesitan estudios que investiguen la mejor estrategia diagnóstico-terapéutica en estos pacientes.

Referencias bibliográficas

  • 1. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education:a cross-sectional study. Lancet. 2012;380:37-43.
  • 2. Sanchis J, Núñez J, BodíV, Núñez E, García-Alvarez A, Bonanad C, et al. Influence of comorbid conditions on one-year outcomes in non-ST-segment elevation acute coronary syndrome. Mayo Clin Proc. 2011;86:291-296.
  • 3. Chirinos JA, Veerani A, Zambrano JP, Schob A, Perez G, Mendez AJ, et al. Evaluation of comorbidity scores to predict all-cause mortality in patients with established coronary artery disease. Int J Cardiol. 2007;117:97-102.
  • 4. Sanchis J, Bonanad C, Ruiz V, Fernández J, García-Blas S, Mainar L, et al. Frailty and other geriatric conditions for risk stratification of older patients with acute coronary syndrome. Am Heart J. 2014;168:784-791.
  • 5. Bardaji A, Barrabés JA, Ribera A, et al. Revascularization in older adult patients with non-ST-segment elevation acute coronary syndrome:effect and impact on 6-month mortality [published online ahead of print, 2019 May 14]. Eur Heart J Acute Cardiovasc Care. 2019;2048∖19849922.
  • 6. Chuang AM, Hancock DG, Halabi A, et al. Invasive management of acute coronary syndrome:Interaction with competing risks. Int J Cardiol. 2018;269:13-18.
  • 7. Tegn N, Abdelnoor M, Aaberge L, et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study):an open-label randomized controlled trial. Lancet. 2016;387:1057-1065.
  • 8. Sanchis J, Núñez E, Barrabés JA, et al. Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction. Eur J Intern Med. 2016;35:89-94.
  • 9. Palau P, Núñez J, Sanchis J, et al. Differential prognostic effect of revascularization according to a simple comorbidity index in high-risk non-ST-segment elevation acute coronary syndrome. Clin Cardiol. 2012;35:237-243.
  • 10. Savonitto S, Morici N, De Servi S. Treatment of acute coronary syndromes in the elderly and in patients with comorbidities. Rev Esp Cardiol. 2014;67:564-573.
  • 11. Roffi M, Patrono C, Collet JP, et al. 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation:Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37:267-315.
  • 12. Camprubi M, Cabrera S, Sans J, et al. Body Mass Index and Hospital Mortality in Patients with Acute Coronary Syndrome Receiving Care in a University Hospital. J Obes. 2012;2012:287939.
  • 13. Ariza-SoléA, Sánchez-Salado JC, Lorente V, et al. Is it possible to separate ischemic and bleeding risk in patients with non-ST segment elevation acute coronary syndromes?Int J Cardiol. 2014;171:448-450.
  • 14. Alonso Salinas GL, Sanmartín Fernández M, Pascual Izco M, et al. Frailty predicts major bleeding within 30 days in elderly patients with Acute Coronary Syndrome. Int J Cardiol. 2016;222:590-593.
  • 15. Cordero A, López-Palop R, Carrillo P, et al. Prevalence and Postdischarge Incidence of Malignancies in Patients With Acute Coronary Syndrome. Rev Esp Cardiol. 2018;71:267-273.
  • 16. Alegre O, Formiga F, López-Palop R, et al. An Easy Assessment of Frailty at Baseline Independently Predicts Prognosis in Very Elderly Patients With Acute Coronary Syndromes. J Am Med Dir Assoc. 2018;19:296-303.
  • 17. Rivera-Caravaca JM, Ruiz-Nodar JM, Tello-Montoliu A, et al. Disparities in the Estimation of Glomerular Filtration Rate According to Cockcroft-Gault, Modification of Diet in Renal Disease-4, and Chronic Kidney Disease Epidemiology Collaboration Equations and Relation With Outcomes in Patients With Acute Coronary Syndrome. J Am Heart Assoc. 2018;7:e008725.
  • 18. Abu-Assi E, Raposeiras-Roubin S, Cobas-Paz R, et al. Assessing the performance of the PRECISE-DAPT and PARIS risk scores for predicting one-year out-of-hospital bleeding in acute coronary syndrome patients. EuroIntervention. 2018;13:1914-1922.
  • 19. Álvarez Álvarez B, Abou Jokh Casas C, Cordero A, et al. Early revascularization and long-term mortality in high-risk patients with non-ST-elevation myocardial infarction. The CARDIOCHUS-HUSJ registry. Rev Esp Cardiol. 2020;73:35-42.
  • 20. MilàL, Barrabés JA, Lidón RM, et al. Prior adherence to recommended lipid control targets in patients admitted for acute coronary syndrome. Rev Esp Cardiol. 2019;73:376-382.
  • 21. Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome:estimating the risk of 6-month postdischarge death in an international registry. JAMA. 2004:291:2727-2733.
  • 22. Sanchis J, Soler M, Núñez J, et al. Comorbidity assessment for mortality risk stratification in elderly patients with acute coronary syndrome. Eur J Intern Med. 2019;62:48-53.
  • 23. Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies:development and validation. J Chronic Dis. 1987;40:373-383.
  • 24. Núñez J, Núñez E, Fácila L, et al. Prognostic value of Charlson comorbidity index at 30 days and 1 year after acute myocardial infarction. Rev Esp Cardiol. 2004;57:842-849.
  • 25. De Servi S, Cavallini C, Dellavalle A, et al. Non-ST-elevation acute coronary syndrome in the elderly:treatment strategies and 30-day outcome. Am Heart J. 2004;147:830-836.
  • 26. Sillano D, Resmini C, Meliga E, et al. Retrospective multicenter observational study of the interventional management of coronary disease in the very elderly:the NINETY. Catheter Cardiovasc Interv. 2013;82:414-421.
  • 27. Kolte D, Khera S, Palaniswamy C, et al. Early invasive versus initial conservative treatment strategies in octogenarians with UA/NSTEMI. Am J Med. 2013;126:1076-1083.
  • 28. Núñez J, Ruiz V, Bonanad C, et al. Percutaneous coronary intervention and recurrent hospitalizations in elderly patients with non ST-segment acute coronary syndrome:The role of frailty. Int J Cardiol. 2017;228:456-458.
  • 29. LlaóI, Ariza-SoléA, Sanchis J, et al. Invasive strategy and frailty in very elderly patients with acute coronary syndromes. EuroIntervention. 2018;14:e336-342.
  • 30. Sanchis J, Ariza-SoléA, Abu-Assi E, et al. Invasive Versus Conservative Strategy in Frail Patients With NSTEMI:The MOSCA-FRAIL Clinical Trial Study Design. Rev Esp Cardiol. 2019;72:154-159.
  • 31. de Groot V, Beckerman H, Lankhorst GJ, et al. How to measure comorbidity. A critical review of available methods. J Clin Epidemiol. 2003;56:221-229.
  • 32. Park JY, Kim MH, Bae EJ, et al. Comorbidities can predict mortality of kidney transplant recipients:comparison with the Charlson comorbidity index. Transplant Proc. 2018;50:1068-1073.
  • 33. Chirinos JA, Veerani A, Zambrano JP, et al. Evaluation of comorbidity scores to predict all-cause mortality in patients with established coronary artery disease. Int J Cardiol. 2007;117:97-102.
  • 34. Lawler PR, Filion KB, Dourian T, et al. Anemia and mortality in acute coronary syndromes:a systematic review and meta-analysis. Am Heart J. 2013;165:143-153.
  • 35. Ford I, Bezlyak V, Stott DJ, et al. Reduced glomerular filtration rate and its association with clinical outcome in older patients at risk of vascular events:secondary analysis. PLoS Med. 2009;6:e16.
  • 36. Sabatine MS, Morrow DA, Giugliano RP, et al. Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation. 2005;111:2042-2049.
  • 37. Vicente-Ibarra N, Marín F, Pernias-Escrig V, et al. Impact of anemia as risk factor for major bleeding and mortality in patients with acute coronary syndrome. Eur J Intern Med. 2019;61:48-53.
  • 38. Goldenberg I, Subirana I, Boyko V, et al. Relation between renal function and outcomes in patients with non-ST-segment elevation acute coronary syndrome:real-world data from the European Public Health Outcome Research and Indicators Collection Project. Arch Intern Med. 2010;170:888-895.
  • 39. Rao Kondapally Seshasai S, Kaptoge S, Thompson A, et al. Diabetes mellitus, fasting glucose, and risk of cause-specific death [published correction appears in N Engl J Med. 2011;364:1281]. N Engl J Med. 2011;364:829-841.
  • 40. Rothnie KJ, Smeeth L, Herrett E, et al. Closing the mortality gap after a myocardial infarction in people with and without chronic obstructive pulmonary disease. Heart. 2015;101:1103-1110.
  • 41. Avezum A, Makdisse M, Spencer F, et al. Impact of age on management and outcome of acute coronary syndrome:observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2005;149:67?73.
  • 42. Itzahki Ben Zadok O, Ben-Gal T, Abelow A, et al. Temporal Trends in the Characteristics, Management and Outcomes of Patients With Acute Coronary Syndrome According to Their Killip Class. Am J Cardiol. 2019;124:1862?1868.
  • 43. Mehta LS, Beckie TM, DeVon HA, et al. Acute Myocardial Infarction in Women:A Scientific Statement From the American Heart Association. Circulation. 2016;133:916?947.
  • 44. Yudi MB, Clark DJ, Farouque O, et al. Trends and predictors of recurrent acute coronary syndrome hospitalizations and unplanned revascularization after index acute myocardial infarction treated with percutaneous coronary intervention. Am Heart J. 2019;212:134?143.
Fuente de los datos: Dialnet