1 / 24

The Trans Radial Intervention and Patient Subsets (I)

The Trans Radial Intervention and Patient Subsets (I). The Very Old and The Very Sick Octogenerians, Acute Coronary Syndromes. M.Heigert Landeskrankenhaus Salzburg Bad Gastein 10.02.2007. Europes Old Age Epidemia. 2004. 2050. 20 % of Europes population will be over 80 in the year of 2050.

fatima-ortega
Download Presentation

The Trans Radial Intervention and Patient Subsets (I)

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The Trans Radial Intervention and Patient Subsets (I) The Very Old and The Very Sick Octogenerians, Acute Coronary Syndromes M.Heigert Landeskrankenhaus Salzburg Bad Gastein 10.02.2007

  2. Europes Old Age Epidemia 2004 2050

  3. 20 % of Europes population will be over 80 in the year of 2050 Current life expectancy: 82 - 85 years

  4. CHD in Salzburg 2004 - 2006 (without valves): diagnostic procedures in different age groups 39,2 % aller Koronarpatienten >70

  5. Salzburg 2004-2006 valve-diseases pre-op diagnostic coronary angiogram n=216 57,9% aller Klappenpatienten über 70, 18% über 80

  6. Euro Heart Service on PCI 2006 n=13151 > 75 < 75

  7. Implications of old age • Reduced life expectancy • Reduced physiologic reserves • Higher comorbidities: • peripheral artery disease • renal insufficiency • diabetes • lung diseases / COAD • complex CHD • Higher risks

  8. EHS 2006: risk-profile in the elderly

  9. PCI in Elderly: cardiovascular history EHS 2006

  10. PCI in Elderly: urgency STEMI: 18/18%, NSTEMIEHS 2006 16/12%, UAP 8/6%

  11. Number of diseased vessels Dsignificantly more 3-VD in the elderly EHS 2006. häufiger

  12. Salzburg: January - June 2006 Salzburg 1-9/06: ACS patients 75 years : n = 137

  13. Trial of Invasive vs. Medical Therapy in Elderly Patients With Chronic Symptomatic Coronary-Artery Disease (TIME): A Randomized Trial 148 pts aged 75 years or older with chronic angina of Canadian Cardiac Society class II or more despite treatment with 2 antianginal drugs were assigned to medical therapy and 153 to invasive therapy. Primary end points were quality of life and a composite of death, nonfatal MI, or hospital admission for ACS at 6 months. Conclusion: Pts aged 75 or older with angina despite standard drug therapy benefit more from revascularization than from medical therapy. The TIME Investigators, Lancet2001;358:951-957.

  14. PCI Inhosp. Outcome in old aged patients EHS 2006

  15. The REPLACE-2 Trial (N=6010):Trial Design 6010 Urgent or elective PCI patients Aspirin Clopidogrel Stent Bivalirudin Provisional GPIIb/IIIa Endpoints 30-day Death MI Revasc Hemorrhage Economics 6, 12m follow up 2999 Heparin 65 U/kg Abciximab or Eptifibatide 3011 Lincoff AM, et al. JAMA 2003; 289: 853-863.

  16. The REPLACE-2 Trial (N=6010):Primary Endpoint at 30 Days p = 0.324 p = 0.255 p = 0.430 p = 0.435 p < 0.001 % of patients Major bleeding • Intracranial, intraocular, or retroperitoneal • Observed bleed with fall in Hgb >3g/dL • No observed bleed with fall in Hgb >4g/dL • Transfusion 2 units PRBC or whole blood Lincoff AM, et al. JAMA 2003; 289: 853-863.

  17. The REPLACE-2 Trial (N=6010):Major Bleeding and Mortality in PCI Feit F, Voeltz MD, Attubato MA, et al. Unpublished.

  18. = Not Elderly, <75 (N=5196) = Elderly, >75 (N=805) The REPLACE-2 Trial (N=6010):Bleeding and Transfusion by Age p<0.0001 p<0.0001 Voeltz MD. et al. Circulation 2005;112(17):II-613.

  19. = Elderly, No Major Bleed (N=751) = Elderly, Major Bleed (N=54) The REPLACE-2 Trial (N=6010):Mortality Among Elderly by Bleeding Status p<0.01 p<0.01 p<0.01 Mortality Nelson MA, et al. AHA 2006.

  20. The REPLACE-2 Trial (N=6010):Mortality with Transfusion in PCI Non-transfused Transfused *p<0.0001 Manoukian SV, Voeltz MD, Attubato MJ, Bittl JA, Feit F, Lincoff AM. CRT 2005.

  21. The REPLACE-2 Trial (N=6010):Predictors of Major Bleeding in PCI Feit F, Voeltz MD, Attubato MA, et al. Unpublished.

  22. The REPLACE-2 Trial (N=6010):Predictors of One-Year Mortality in PCI Major Bleeding REPLACE-2 • Intracranial, retroperitoneal • Observed bleed with fall in Hgb 3g/dL • No observed bleed with fall in Hgb 4g/dL • Transfusion 2 units PRBC or whole blood Voeltz MD, Patel AD, press. Feit F, et al. Am J Cardiol, in

  23. Concl. • 3/4 of the old age patients >75 years >= 2VD • 2/3 of these patients are only intervened at one vessel (incomplete) • Even more than in younger patients the PCI-interventions is good for palliation • Higher mortality in this high risk group • Mortality and reinfarctions mainly correlate with the high bleeding risk and other vascular complications caused at the entry site

More Related