Health Status and Clinical Outcomes in Older Adults With Chronic Coronary Disease

被引：12

作者：

Nguyen, Dan D. ^{[1
,2
]}

Spertus, John A. ^{[1
,2
]}

Alexander, Karen P. ^{[3
]}

Newman, Jonathan D. ^{[4
]}

Dodson, John A. ^{[4
]}

Jones, Philip G. ^{[1
,2
]}

Stevens, Susanna R. ^{[3
]}

O'Brien, Sean M. ^{[3
]}

Gamma, Reto ^{[5
]}

Perna, Gian P. ^{[6
]}

Garg, Pallav ^{[7
]}

Vitola, Joao V. ^{[8
]}

Chow, Benjamin J. W. ^{[9
]}

Vertes, Andras ^{[10
]}

White, Harvey D. ^{[11
,12
]}

Smanio, Paola E. P. ^{[13
]}

Senior, Roxy ^{[14
]}

Held, Claes ^{[15
,16
]}

Li, Jianghao ^{[3
]}

Boden, William E. ^{[17
]}

Mark, Daniel B. ^{[3
]}

Reynolds, Harmony R. ^{[4
]}

Bangalore, Sripal ^{[4
]}

Chan, Paul S. ^{[1
,2
]}

Stone, Gregg W. ^{[18
,19
]}

Arnold, Suzanne V. ^{[1
,2
]}

Maron, David J. ^{[20
]}

Hochman, Judith S. ^{[4
]}

机构：

[1] St Lukes Mid Amer Heart Inst, 4401 Wornall Rd, Kansas City, MO 64011 USA

[2] Univ Missouri, Kansas City, MO USA

[3] Duke Cln Res Inst, Durham, NC USA

[4] NYU, Grossman Sch Med, New York, NY USA

[5] Univ Hosp Inselspital, Swiss Cardiovasc Ctr, Dept Cardiol, Bern, Switzerland

[6] Ospedali Riuniti Ancona, Dept Cardiol, Ancona, Italy

[7] London Hlth Sci Ctr, London, ON, Canada

[8] Quanta Diagnost, Curitiba, Brazil

[9] Univ Ottawa, Heart Inst, Ottawa, ON, Canada

[10] Del Pest Centrumkohaz Hosp, Natl Inst Hematol & Infect Dis, Cardiovasc Dept, Budapest, Hungary

[11] Auckland City Hosp, Green Lane Cardiovasc Serv, Auckland, New Zealand

[12] Univ Auckland, Auckland, New Zealand

[13] Inst Dante Pazzanese Cardiol & Fleury Med & Saude, Sao Paulo, Brazil

[14] Northwick Pk Hosp & Clin Res Ctr, Royal Brompton Hosp, Dept Med, London, England

[15] Uppsala Univ, Dept Med Sci, Cardiol, Uppsala, Sweden

[16] Uppsala Clin Res Ctr, Uppsala, Sweden

[17] Vet Affairs, New England Healthcare Syst, Boston, MA USA

[18] Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY USA

[19] Cardiovasc Res Fdn, New York, NY USA

[20] Stanford Univ, Dept Med, Palo Alto, CA USA

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2023年 / 81卷 / 17期

基金：

美国国家卫生研究院;

关键词：

coronary artery disease; older adults; quality of life; SEATTLE ANGINA QUESTIONNAIRE; HEART-ASSOCIATION COUNCIL; OPTIMAL MEDICAL THERAPY; QUALITY-OF-LIFE; ELDERLY-PATIENTS; MYOCARDIAL-INFARCTION; SCIENTIFIC STATEMENT; CARE PROFESSIONALS; RISK; INTERVENTION;

D O I：

10.1016/j.jacc.2023.02.048

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Whether initial invasive management in older vs younger adults with chronic coronary disease and moderate or severe ischemia improves health status or clinical outcomes is unknown. OBJECTIVES The goal of this study was to examine the impact of age on health status and clinical outcomes with invasive vs conservative management in the ISCHEMIA (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches) trial. METHODS One-year angina-specific health status was assessed with the 7-item Seattle Angina Questionnaire (SAQ) (score range 0-100; higher scores indicate better health status). Cox proportional hazards models estimated the treatment effect of invasive vs conservative management as a function of age on the composite clinical outcome of cardiovascular death, myocardial infarction, or hospitalization for resuscitated cardiac arrest, unstable angina, or heart failure. RESULTS Among 4,617 participants, 2,239 (48.5%) were aged <65 years, 1,713 (37.1%) were aged 65 to 74 years, and 665 (14.4%) were aged $75 years. Baseline SAQ summary scores were lower in participants aged <65 years. Fully adjusted differences in 1-year SAQ summary scores (invasive minus conservative) were 4.90 (95% CI: 3.56-6.24) at age 55 years, 3.48 (95% CI: 2.40-4.57) at age 65 years, and 2.13 (95% CI: 0.75-3.51) at age 75 years (Pinteraction = 0.008). Improvement in SAQ Angina Frequency was less dependent on age (Pinteraction = 0.08). There were no age differences between invasive vs conservative management on the composite clinical outcome (Pinteraction = 0.29). CONCLUSIONS Older patients with chronic coronary disease and moderate or severe ischemia had consistent improvement in angina frequency but less improvement in angina-related health status with invasive management compared with younger patients. Invasive management was not associated with improved clinical outcomes in older or younger patients. (International Study of Comparative Health Effectiveness with Medical and Invasive Approaches [ISCHEMIA]; NCT01471522) (J Am Coll Cardiol 2023;81:1697-1709) & COPY; 2023 by the American College of Cardiology Foundation.

引用

页码：1697 / 1709

页数：13

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