Trattamento delle sindromi coronariche acute nel paziente anziano: Insegnamenti dell'Italian Elderly ACS Study

Translated title of the contribution: Treatment of acute coronary syndromes in elderly patients: Lessons of the Italian Elderly ACS Study

Stefano Savonitto, Roberto Antonicelli, Daniele Caraceni, Fabrizio D'Ambrosi, Stefano De Servi

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Elderly patients account for one third of those admitted to cardiac care units with non-ST-elevation acute coronary syndromes, but are largely underrepresented in randomized clinical trials which form the basis of practice guidelines. Conducting trials in this patient population is especially difficult due to coexisting pathologies, informed consent issues, a perceived higher risk of interventional procedures, and complexity of follow-up. The Italian Elderly ACS Study has been a positive experience in terms of accepting this challenge, carrying it on with limited resources and delineating convincing results, although not statistically conclusive due to its final limited sample size. The indications from the study are straightforward in patients with elevated troponin levels on admission and other high-risk characteristics: in these patients, an early invasive approach has reduced by 40% to 60% the risk of fatal and nonfatal ischemic complications at 1-year follow-up. This result has been achieved with an incidence of bleeding complications which was by far lower than previously reported in the literature, probably due to a systematic radial approach to vascular interventions and a cautious use of antithrombotic treatments in the acute phase.

Original languageItalian
JournalGiornale Italiano di Cardiologia
Volume13
Issue number10 SUPPL.2
DOIs
Publication statusPublished - Oct 2012

Fingerprint

Acute Coronary Syndrome
Troponin
Therapeutics
Informed Consent
Practice Guidelines
Sample Size
Blood Vessels
Randomized Controlled Trials
Pathology
Hemorrhage
Incidence
Population

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{6462a8be8d2748448832e763354ffac1,
title = "Trattamento delle sindromi coronariche acute nel paziente anziano: Insegnamenti dell'Italian Elderly ACS Study",
abstract = "Elderly patients account for one third of those admitted to cardiac care units with non-ST-elevation acute coronary syndromes, but are largely underrepresented in randomized clinical trials which form the basis of practice guidelines. Conducting trials in this patient population is especially difficult due to coexisting pathologies, informed consent issues, a perceived higher risk of interventional procedures, and complexity of follow-up. The Italian Elderly ACS Study has been a positive experience in terms of accepting this challenge, carrying it on with limited resources and delineating convincing results, although not statistically conclusive due to its final limited sample size. The indications from the study are straightforward in patients with elevated troponin levels on admission and other high-risk characteristics: in these patients, an early invasive approach has reduced by 40{\%} to 60{\%} the risk of fatal and nonfatal ischemic complications at 1-year follow-up. This result has been achieved with an incidence of bleeding complications which was by far lower than previously reported in the literature, probably due to a systematic radial approach to vascular interventions and a cautious use of antithrombotic treatments in the acute phase.",
keywords = "Acute coronary syndromes, Elderly, Italian Elderly ACS Study",
author = "Stefano Savonitto and Roberto Antonicelli and Daniele Caraceni and Fabrizio D'Ambrosi and {De Servi}, Stefano",
year = "2012",
month = "10",
doi = "10.1714/1167.12923",
language = "Italian",
volume = "13",
journal = "Giornale Italiano di Cardiologia",
issn = "1827-6806",
publisher = "CEPI s.r.l.",
number = "10 SUPPL.2",

}

TY - JOUR

T1 - Trattamento delle sindromi coronariche acute nel paziente anziano

T2 - Insegnamenti dell'Italian Elderly ACS Study

AU - Savonitto, Stefano

AU - Antonicelli, Roberto

AU - Caraceni, Daniele

AU - D'Ambrosi, Fabrizio

AU - De Servi, Stefano

PY - 2012/10

Y1 - 2012/10

N2 - Elderly patients account for one third of those admitted to cardiac care units with non-ST-elevation acute coronary syndromes, but are largely underrepresented in randomized clinical trials which form the basis of practice guidelines. Conducting trials in this patient population is especially difficult due to coexisting pathologies, informed consent issues, a perceived higher risk of interventional procedures, and complexity of follow-up. The Italian Elderly ACS Study has been a positive experience in terms of accepting this challenge, carrying it on with limited resources and delineating convincing results, although not statistically conclusive due to its final limited sample size. The indications from the study are straightforward in patients with elevated troponin levels on admission and other high-risk characteristics: in these patients, an early invasive approach has reduced by 40% to 60% the risk of fatal and nonfatal ischemic complications at 1-year follow-up. This result has been achieved with an incidence of bleeding complications which was by far lower than previously reported in the literature, probably due to a systematic radial approach to vascular interventions and a cautious use of antithrombotic treatments in the acute phase.

AB - Elderly patients account for one third of those admitted to cardiac care units with non-ST-elevation acute coronary syndromes, but are largely underrepresented in randomized clinical trials which form the basis of practice guidelines. Conducting trials in this patient population is especially difficult due to coexisting pathologies, informed consent issues, a perceived higher risk of interventional procedures, and complexity of follow-up. The Italian Elderly ACS Study has been a positive experience in terms of accepting this challenge, carrying it on with limited resources and delineating convincing results, although not statistically conclusive due to its final limited sample size. The indications from the study are straightforward in patients with elevated troponin levels on admission and other high-risk characteristics: in these patients, an early invasive approach has reduced by 40% to 60% the risk of fatal and nonfatal ischemic complications at 1-year follow-up. This result has been achieved with an incidence of bleeding complications which was by far lower than previously reported in the literature, probably due to a systematic radial approach to vascular interventions and a cautious use of antithrombotic treatments in the acute phase.

KW - Acute coronary syndromes

KW - Elderly

KW - Italian Elderly ACS Study

UR - http://www.scopus.com/inward/record.url?scp=84872172079&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84872172079&partnerID=8YFLogxK

U2 - 10.1714/1167.12923

DO - 10.1714/1167.12923

M3 - Articolo

C2 - 23096378

AN - SCOPUS:84872172079

VL - 13

JO - Giornale Italiano di Cardiologia

JF - Giornale Italiano di Cardiologia

SN - 1827-6806

IS - 10 SUPPL.2

ER -