Clinical characteristics and intravascular ultrasound findings of culprit lesions in elderly patients with acute coronary syndrome View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2014-12-19

AUTHORS

Yuji Ogura, Kenichi Tsujita, Hideki Shimomura, Kenshi Yamanaga, Naohiro Komura, Takashi Miyazaki, Masanobu Ishii, Noriaki Tabata, Tomonori Akasaka, Yuichiro Arima, Kenji Sakamoto, Sunao Kojima, Sunao Nakamura, Koichi Kaikita, Seiji Hokimoto, Hisao Ogawa

ABSTRACT

Acute coronary syndrome (ACS) is one of the main causes of cardiovascular death. According to rapid aging of society, the peak age of ACS onset has grown older globally. Despite growing recognition of the necessity to build the ACS prevention strategy in the elderly, patients background and culprit lesion morphology of these elderly ACS patients have not been well studied. We sought to assess the clinical characteristics and intravascular ultrasound (IVUS) findings of the culprit lesions in elderly ACS patients. One-hundred and fifty-eight consecutive ACS patients whose culprit lesions imaged by pre-intervention IVUS were divided into two groups based on the age of onset: elderly [E] group (≥75 years, n = 65) and non-elderly [NE] group (<75 years, n = 93). As compared with NE group, hemoglobin (12.7 ± 2.0 g/dL vs. 13.7 ± 1.6 g/dL, p = 0.001), estimated glomerular filtration rate (62.5 ± 22.5 mL/min/1.73 m2 vs. 75.5 ± 20.5 mL/min/1.73 m2, p = 0.0001), and body mass index (22.9 ± 3.4 kg/m2 vs. 24.5 ± 3.4 kg/m2, p = 0.003) were significantly lower, and comorbid malignancy was more common (20.0 vs 6.5 %, p = 0.01) in E group. Although whole culprit segment was not positively remodeled (mean vessel area was 15.2 ± 5.6 mm3/mm vs. 16.2 ± 5.1 mm3/mm, p = 0.16) in E group, at maximum external elastic membrane site of the culprit lesion, lumen area was smaller (5.5 ± 3.2 mm2 vs. 6.7 ± 3.5 mm2, p = 0.04), and plaque burden tended to be more abundant (70 ± 13 vs. 66 ± 13 %, p = 0.08). Interestingly, echo attenuation arc of culprit attenuated plaque was significantly greater in E group than in NE group (157 ± 83° vs. 118 ± 60°, p = 0.01). In conclusion, extracardiac comorbidity was more common in elderly ACS patients, and their culprit coronary lesions were still rupture prone, and “vulnerable.” More... »

PAGES

341-350

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00380-014-0616-2

DOI

http://dx.doi.org/10.1007/s00380-014-0616-2

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1011629944

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/25523892


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    "description": "Acute coronary syndrome (ACS) is one of the main causes of cardiovascular death. According to rapid aging of society, the peak age of ACS onset has grown older globally. Despite growing recognition of the necessity to build the ACS prevention strategy in the elderly, patients background and culprit lesion morphology of these elderly ACS patients have not been well studied. We sought to assess the clinical characteristics and intravascular ultrasound (IVUS) findings of the culprit lesions in elderly ACS patients. One-hundred and fifty-eight consecutive ACS patients whose culprit lesions imaged by pre-intervention IVUS were divided into two groups based on the age of onset: elderly [E] group (\u226575\u00a0years, n\u00a0=\u00a065) and non-elderly [NE] group (<75\u00a0years, n\u00a0=\u00a093).\u00a0As compared with NE group, hemoglobin (12.7\u00a0\u00b1\u00a02.0\u00a0g/dL vs. 13.7\u00a0\u00b1\u00a01.6\u00a0g/dL, p\u00a0=\u00a00.001), estimated glomerular filtration rate (62.5\u00a0\u00b1\u00a022.5\u00a0mL/min/1.73\u00a0m2\u00a0vs. 75.5\u00a0\u00b1\u00a020.5\u00a0mL/min/1.73\u00a0m2, p\u00a0=\u00a00.0001), and body mass index (22.9\u00a0\u00b1\u00a03.4\u00a0kg/m2\u00a0vs. 24.5\u00a0\u00b1\u00a03.4\u00a0kg/m2, p\u00a0=\u00a00.003) were significantly lower, and comorbid malignancy was more common (20.0 vs 6.5\u00a0%, p\u00a0=\u00a00.01) in E group. Although whole culprit segment was not positively remodeled (mean vessel area was 15.2\u00a0\u00b1\u00a05.6\u00a0mm3/mm vs. 16.2\u00a0\u00b1\u00a05.1\u00a0mm3/mm, p\u00a0=\u00a00.16) in E group, at maximum external elastic membrane site of the culprit lesion, lumen area was smaller (5.5\u00a0\u00b1\u00a03.2\u00a0mm2\u00a0vs. 6.7\u00a0\u00b1\u00a03.5\u00a0mm2, p\u00a0=\u00a00.04), and plaque burden tended to be more abundant (70\u00a0\u00b1\u00a013 vs. 66\u00a0\u00b1\u00a013\u00a0%, p\u00a0=\u00a00.08). Interestingly, echo attenuation arc of culprit attenuated plaque was significantly greater in E group than in NE group (157\u00a0\u00b1\u00a083\u00b0 vs. 118\u00a0\u00b1\u00a060\u00b0, p\u00a0=\u00a00.01). In conclusion, extracardiac comorbidity was more common in elderly ACS patients, and their culprit coronary lesions were still rupture prone, and \u201cvulnerable.\u201d", 
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