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
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Journal:
REC: Interventional Cardiology

ISSN: 2604-7276,  2604-7306

Year of publication: 2021

Volume: 3

Issue: 1

Pages: 15-20

Type: Article

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

More publications in: REC: Interventional Cardiology

Abstract

Introduction and objectives: The presence of comorbidities in elderly patients with non-ST-segment elevation acute coronary syndrome worsens its prognosis. The objective of the study was to analyze the impact of the burden of comorbidities in the decision of using invasive management in these patients. Methods: A total of 7211 patients > 70 years old from 11 Spanish registries were included. Individual data were analyzed in a common database. We assessed the presence of 6 comorbidities and their association with coronary angiography during admission. Results: The mean age was 79 ± 6 years and the mean CRACE score was 150 ± 21 points. A total of 1179 patients (16%) were treated conservatively. The presence of each comorbidity was associated with less invasive management (adjusted for predictive clinical variables): cerebrovascular disease (OR, 0.78; 95%CI, 0.64-0.95; P = .01), anemia (OR, 0.64; 95%CI, 0.54-0.76; P < .0001), chronic kidney disease (OR, 0.65; 95%CI, 0.56-0.75; P < .0001), peripheral arterial disease (OR, 0.79; 95%CI, 0.65-0.96; P = .02), chronic lung disease (OR, 0.85; IC95%, 0.71-0.99; P = .05), and diabetes mellitus (OR, 0.85; 95%CI, 0.74-0.98; P < .03). The increase in the number of comorbidities (comorbidity burden) was associated with a reduction in coronary angiographies GRACE score: 1 comorbidity (OR, 0.66; 95%CI, 0.54-0.81), 2 comorbidities (OR, 0.55; 95%CI, 0.45-0.69), 3 comorbidities (OR, 0.37; 95%CI, 0.29-0.47), 4 comorbidities (OR, 0.33; 95%CI, 0.24-0.45), ≥ 5 comorbidities (OR, 0.21; 95%CI, 0.12-0.36); all P values < .0001 compared to 0. Conclusions: The number of coronary angiographies performed drops as the number of comorbidities increases in elderly patients with non-ST-segment elevation acute coronary syndrome. More studies are still needed to know what the best management of these patients should be.

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