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Clinical Updates and Future Perspectives on the Management of Myocardial...
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Clinical Updates and Future Perspectives on the Management of Myocardial Infarction in Elderly Patients

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 August 2021) | Viewed by 9730

Special Issue Editor

Dr. Simone Biscaglia

E-Mail Website
Guest Editor
Ferrara University Hospital, Cona, FE, Italy
Interests: myocardial infarction; coronary physiology; elderly patients; frailty; bioresorbable scaffolds; physical activity; intracoronary imaging; antiplatelet therapy

Special Issue Information

Dear Colleagues,

Myocardial infarction (MI) in elderly patients is associated with an unfavorable prognosis, and it is becoming an increasingly prevalent condition. The prognosis of elderly patients is equally impaired in ST-segment elevation (STE) or non-STE (NSTE), with the latter being the most frequent clinical presentation in this population. In addition, the outcome is markedly worsened by the common presence of multivessel disease (MVD) and of a high bleeding risk (HBR). Elderly patients have been mostly excluded from randomized clinical trials and the evidence regarding their treatment is limited.

In particular, there are three main gaps in knowledge:

  1. the strategy to pursue in NSTEMI patients: routine invasive vs conservative.
  2. whether, as for younger patients, a complete revascularization strategy in MI patients with MVD should be advocated.
  3. how to properly balance the concomitant ischemic and bleeding risk in this population with particular regard to dual antiplatelet therapy (DAPT) duration and intensity. Artificial intelligence could be particularly intriguing in the estimation of the two competing risks.

The present Special Issue of the Journal of Clinical Medicine welcomes submissions on these topics, since it is very important to generate data in order to fill these gaps.

Dr. Simone Biscaglia
Guest Editor

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Myocardial Infarction (STEMI/NSTEMI)
  • Elderly Patients
  • Invasive Management
  • Multivessel Disease
  • Revascularization Strategy
  • Coronary Physiology
  • Bleeding Risk
  • Dual Antiplatelet Therapy
  • Artificial Intelligence

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Published Papers (4 papers)

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Research

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9 pages, 630 KiB  
Article
Prognosis Impact of Diabetes in Elderly Women and Men with Non-ST Elevation Acute Coronary Syndrome
by Pablo Díez-Villanueva, Jose María García-Acuña, Sergio Raposeiras-Roubin, Jose A. Barrabés, Alberto Cordero, Manuel Martínez-Sellés, Alfredo Bardají, Francisco Marín, Juan M. Ruiz-Nodar, Nuria Vicente-Ibarra, Gonzalo L. Alonso Salinas, Belén Cid-Alvárez, Emad Abu Assi, Frances Formiga, Julio Núñez, Eduardo Núñez, Albert Ariza-Solé and Juan Sanchis
J. Clin. Med. 2021, 10(19), 4403; https://doi.org/10.3390/jcm10194403 - 26 Sep 2021
Cited by 6 | Viewed by 2038
Abstract
Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients [...] Read more.
Few studies have addressed to date the interaction between sex and diabetes mellitus (DM) in the prognosis of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). Our aim was to address the role of DM in the prognosis of non-selected elderly patients with NSTEACS according to sex. A retrospective analysis from 11 Spanish NSTEACS registries was conducted, including patients aged ≥70 years. The primary end point was one-year all-cause mortality. A total of 7211 patients were included, 2,770 (38.4%) were women, and 39.9% had DM. Compared with the men, the women were older (79.95 ± 5.75 vs. 78.45 ± 5.43 years, p < 0.001) and more often had a history of hypertension (77% vs. 83.1%, p < 0.01). Anemia and chronic kidney disease were both more common in women. On the other hand, they less frequently had a prior history of arteriosclerotic cardiovascular disease or comorbidities such as peripheral artery disease and chronic pulmonary disease. Women showed a worse clinical profile on admission, though an invasive approach and in-hospital revascularization were both more often performed in men (p < 0.001). At a one-year follow-up, 1090 patients (15%) had died, without a difference between sexes. Male sex was an independent predictor of mortality (HR = 1.15, 95% CI 1.01 to 1.32, p = 0.035), and there was a significant interaction between sex and DM (p = 0.002). DM was strongly associated with mortality in women (HR: 1.45, 95% CI = 1.18–1.78; p < 0.001), but not in men (HR: 0.98, 95% CI = 0.84–1.14; p = 0.787). In conclusion, DM is associated with mortality in older women with NSTEACS, but not in men. Full article
(This article belongs to the Special Issue Clinical Updates and Future Perspectives on the Management of Myocardial Infarction in Elderly Patients)
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11 pages, 696 KiB  
Article
Contrast Associated Acute Kidney Injury and Mortality in Older Adults with Acute Coronary Syndrome: A Pooled Analysis of the FRASER and HULK Studies
by Rita Pavasini, Matteo Tebaldi, Giulia Bugani, Elisabetta Tonet, Roberta Campana, Paolo Cimaglia, Elisa Maietti, Giovanni Grazzi, Graziella Pompei, Gioele Fabbri, Alessio Fiorio, Andrea Rubboli, Gianni Mazzoni, Francesco Vitali, Matteo Serenelli, Gianluca Campo and Simone Biscaglia
J. Clin. Med. 2021, 10(10), 2151; https://doi.org/10.3390/jcm10102151 - 16 May 2021
Cited by 14 | Viewed by 2119
Abstract
Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent [...] Read more.
Whether contrast-associated acute kidney injury (CA-AKI) is only a bystander or a risk factor for mortality in older patients undergoing percutaneous coronary intervention (PCI) is not well understood. Data from FRASER (NCT02386124) and HULK (NCT03021044) studies have been analysed. All patients enrolled underwent coronary angiography. The occurrence of CA-AKI was defined based on KDIGO criteria. The primary outcome of the study was to test the relation between CA-AKI and 3-month mortality. Overall, 870 older ACS adults were included in the analysis (mean age 78 ± 5 years; 28% females). CA-AKI occurred in 136 (16%) patients. At 3 months, 13 (9.6%) patients with CA-AKI died as compared with 13 (1.8%) without it (p < 0.001). At multivariable analysis, CA-AKI emerged as independent predictor of 3-month mortality (HR 3.51, 95%CI 1.05–7.01). After 3 months, renal function returned to the baseline value in 78 (63%) with CA-AKI. Those without recovered renal function (n = 45, 37%) showed an increased risk of mortality as compared to recovered renal function and no CA-AKI subgroups (HR 2.01, 95%CI 1.55–2.59, p = 0.009 and HR 2.71, 95%CI 1.45–5.89, p < 0.001, respectively). In conclusion, CA-AKI occurs in a not negligible portion of older MI patients undergoing invasive strategy and it is associated with short-term mortality. Full article
(This article belongs to the Special Issue Clinical Updates and Future Perspectives on the Management of Myocardial Infarction in Elderly Patients)
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10 pages, 939 KiB  
Article
Myocardial Infarction in Centenarians. Data from The Polish Registry of Acute Coronary Syndromes
by Jacek Piegza, Lech Poloński, Aneta Desperak, Andrzej Wester, Marianna Janion, Wiesław Mazurek, Wojciech Wojakowski, Adam Witkowski, Dariusz Dudek and Mariusz Gąsior
J. Clin. Med. 2020, 9(10), 3377; https://doi.org/10.3390/jcm9103377 - 21 Oct 2020
Cited by 4 | Viewed by 2091
Abstract
Background: There are no data regarding the mortality rate, risks and benefits of particular reperfusion methods and pharmacological treatment complications in patients aged over 100 years with acute coronary syndromes. We sought to assess the treatment of myocardial infarction (MI) in patients older [...] Read more.
Background: There are no data regarding the mortality rate, risks and benefits of particular reperfusion methods and pharmacological treatment complications in patients aged over 100 years with acute coronary syndromes. We sought to assess the treatment of myocardial infarction (MI) in patients older than 100 years and to determine prognostic factors for this group. Methods: Among the 716,566 patients recorded between 2003 and 2018 in the Polish Registry of Acute Coronary Syndromes, 104 patients aged ≥100 with MI were included. The patients were categorized into two groups: group 1 received conservative treatment (64 patients), and group 2 received invasive strategy (40 patients). Results: The frequencies of in-hospital mortality, MI and stroke were similar in both arms. No difference in the frequency of the combined endpoint (death, reinfarction, stroke) was noted. Invasive treatment was more advantageous for 12-month outcomes; 50 patients in group 1 (79%) and 23 patients in group 2 (57.50%) died (p = 0.017). The multivariate analysis identified the lower left ventricular ejection fraction (EF) (Hazard Ratio (HR) = 0.96; 95% Confidence Interval (CI): 0.94–0.99; p = 0.012), lack of coronary angiography (HR = 0.49; 95% CI: 0.24–0.99; p = 0.048) and cardiac arrest (HR = 4.61; 95% CI: 1.64–12.99; p = 0.0038) as predictors of 12-month mortality in this group. Conclusions: Invasive MI treatment may be beneficial for selected very old patients. Full article
(This article belongs to the Special Issue Clinical Updates and Future Perspectives on the Management of Myocardial Infarction in Elderly Patients)
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Review

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13 pages, 793 KiB  
Review
Tools for the Assessment of the Malnutrition Status and Possible Interventions in Elderly with Cardiovascular Diseases
by Elisabetta Tonet, Roberta Campana, Serena Caglioni, Federico Gibiino, Alessio Fiorio, Giorgio Chiaranda, Silvia Zagnoni, Gianni Casella and Gianluca Campo
J. Clin. Med. 2021, 10(7), 1508; https://doi.org/10.3390/jcm10071508 - 4 Apr 2021
Cited by 11 | Viewed by 2588
Abstract
Malnutrition represents a common and important feature in elderly people affected by cardiovascular diseases. Several studies have investigated its prevalence and prognostic role in most clinical settings, including cardiovascular disease. However, in daily practice it usually remains unrecognized and consequently untreated. The present [...] Read more.
Malnutrition represents a common and important feature in elderly people affected by cardiovascular diseases. Several studies have investigated its prevalence and prognostic role in most clinical settings, including cardiovascular disease. However, in daily practice it usually remains unrecognized and consequently untreated. The present review was ideated to answer the main questions about nutritional status assessment in patients with cardiovascular disease: why, when, where, how to evaluate it, and what to do to improve it. The three main cardiovascular diseases, namely aortic stenosis, ischaemic heart disease, and heart failure were considered. First, the main evidence supporting the prognostic role of malnutrition are summarized and analyzed. Second, the main tools for the assessment of malnutrition in the hospital and outpatient setting are reported for each condition. Finally, the possible strategies and interventions to address malnutrition are discussed. Full article
(This article belongs to the Special Issue Clinical Updates and Future Perspectives on the Management of Myocardial Infarction in Elderly Patients)
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