Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction(NSTEMI)from the MOSCA-FRAIL clinical trial.Metho...Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction(NSTEMI)from the MOSCA-FRAIL clinical trial.Methods The MOSCA-FRAIL trial randomized 167 frail patients,defined by a Clinical Frailty Scale(CFS)≥4,with NSTEMI to an invasive or conservative strategy.The primary endpoint was the number of days alive and out of hospital(DAOH)one year after discharge.For this subanalysis,we compared the impact of an invasive strategy on the outcomes between vulnerable(CFS=4,n=43)and frail(CFS>4,n=124)patients.Results Compared to vulnerable patients,frail patients presented lower values of DAOH(289.8 vs.320.6,P=0.146),more read-missions(1.03 vs.0.58,P=0.046)and higher number of days spent at the hospital during the first year(10.8 vs.3.8,P=0.014).The cau-ses of readmission were mostly non-cardiac(56%).Among vulnerable patients,DAOH were similar regardless of strategy(invasive vs.conservative:325.7 vs.314.7,P=0.684).Among frailest patients,the invasive group tended to have less DAOH(267.7 vs.311.1,P=0.117).Indeed,patients with CFS>4,invasively managed lived 29 days less than their conservative counterparts.In contrast,the-re were no differences in the subgroup with CFS=4.Conclusions Adult patients with frailty and NSTEMI showed different prognosis according to the degree of frailty.A routine in-vasive strategy does not improve outcomes and might be harmful to the frailest patients.展开更多
Objective To assess predictive clinical factors of cardioembolic infarction in very old patients(85 years of age and older).Methods Prospective hospital-based stroke registry("The Sagrat Cor Hospital of Barcelona...Objective To assess predictive clinical factors of cardioembolic infarction in very old patients(85 years of age and older).Methods Prospective hospital-based stroke registry("The Sagrat Cor Hospital of Barcelona Stroke Registry")is an acute-care teaching hospital in Barcelona,Catalonia,Spain.From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period,639 were younger than 85 years of age and 317 were 85 years or older(mean age:88.9 years).Demographics,clinical characteristics,risk factors and early outcome were compared.Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses.Results In a logistic regression model based on demographics,risk factors,clinical features and complications,female gender(odds ratio[OR]=1.74,95%confidence interval[CI]:1.27–2.39),heart failure(OR=2.27,95%CI:1.46–3.56),altered consciousness(OR=1.76,95%CI:1.28–2.42),and infectious complications(OR=2.01,95%CI:1.39–2.91)were predictors of cardioembolic stroke in the oldest age group.By contrast,heavy smoking,heart valve disease,hypertension,headache,early seizures,sensory deficit,and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group.Conclusions Identification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.展开更多
文摘Objective To assess the prognostic impact of a routine invasive strategy according to the frailty burden in patients with non-ST-segment elevation myocardial infarction(NSTEMI)from the MOSCA-FRAIL clinical trial.Methods The MOSCA-FRAIL trial randomized 167 frail patients,defined by a Clinical Frailty Scale(CFS)≥4,with NSTEMI to an invasive or conservative strategy.The primary endpoint was the number of days alive and out of hospital(DAOH)one year after discharge.For this subanalysis,we compared the impact of an invasive strategy on the outcomes between vulnerable(CFS=4,n=43)and frail(CFS>4,n=124)patients.Results Compared to vulnerable patients,frail patients presented lower values of DAOH(289.8 vs.320.6,P=0.146),more read-missions(1.03 vs.0.58,P=0.046)and higher number of days spent at the hospital during the first year(10.8 vs.3.8,P=0.014).The cau-ses of readmission were mostly non-cardiac(56%).Among vulnerable patients,DAOH were similar regardless of strategy(invasive vs.conservative:325.7 vs.314.7,P=0.684).Among frailest patients,the invasive group tended to have less DAOH(267.7 vs.311.1,P=0.117).Indeed,patients with CFS>4,invasively managed lived 29 days less than their conservative counterparts.In contrast,the-re were no differences in the subgroup with CFS=4.Conclusions Adult patients with frailty and NSTEMI showed different prognosis according to the degree of frailty.A routine in-vasive strategy does not improve outcomes and might be harmful to the frailest patients.
文摘Objective To assess predictive clinical factors of cardioembolic infarction in very old patients(85 years of age and older).Methods Prospective hospital-based stroke registry("The Sagrat Cor Hospital of Barcelona Stroke Registry")is an acute-care teaching hospital in Barcelona,Catalonia,Spain.From 956 first-ever cardioembolic stroke patients included in the stroke registry over a 24-year period,639 were younger than 85 years of age and 317 were 85 years or older(mean age:88.9 years).Demographics,clinical characteristics,risk factors and early outcome were compared.Predictors of cardioembolic infarction in the oldest age group were assessed by multivariate analyses.Results In a logistic regression model based on demographics,risk factors,clinical features and complications,female gender(odds ratio[OR]=1.74,95%confidence interval[CI]:1.27–2.39),heart failure(OR=2.27,95%CI:1.46–3.56),altered consciousness(OR=1.76,95%CI:1.28–2.42),and infectious complications(OR=2.01,95%CI:1.39–2.91)were predictors of cardioembolic stroke in the oldest age group.By contrast,heavy smoking,heart valve disease,hypertension,headache,early seizures,sensory deficit,and involvement of the posterior cerebral artery were independently associated with cardioembolic stroke in the younger group.Conclusions Identification of a differential clinical profile of cardioembolic stroke between patients aged 85 years or more and those younger than 85 years helps clinicians to the optimal management of ischemic infarction in the oldest segment of the population.
