Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We comp...Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We compared adults≥18 years old who underwent coronary atherectomy during inpatient PCI in 2016–2023 from the Vizient Clinical Data Base and compared outcomes in younger(<65 years),youngest-old(65–74 years),middle-old(75–84 years),and oldest-old(≥85 years)adults.Primary outcome was in-hospital mortality,and secondary outcomes included postprocedural complications.Results Among 47,337 patients who underwent coronary atherectomy,19,862(42.0%)were younger adults and 27,475(58.0%)were older adults,including 13,583 youngest-old,10,206 middle-old,and 3,686 oldest-old adults.Compared with younger adults,youngest-old adults had higher mortality(adjusted odds ratio[aOR]=1.37,P<0.001),ischemic stroke(aOR=1.35,P=0.005),gastrointestinal hemorrhage(GIH)(aOR=1.44,P<0.001),acute kidney injury(AKI)(aOR=1.43,P<0.001),tamponade(aOR=1.86,P<0.001),and pericardiocentesis(aOR=2.32,P<0.001).Middle-old adults had higher mortality(aOR=1.80,P<0.001),GIH(aOR=1.42,P=0.002),AKI(aOR=1.63,P<0.001),tamponade(aOR=2.52,P<0.001),and pericardiocentesis(aOR=3.13,P<0.001).Oldest-old adults had the highest odds for mortality(aOR=2.03,P<0.001),GIH(aOR=1.48,P=0.016),AKI(aOR=2.26,P<0.001),tamponade(aOR=3.86,P<0.001),and pericardiocentesis(aOR=4.21,P<0.001).There was a significant interaction(P-interaction=0.035)between atherectomy and age groups with regard to the odds of in-hospital mortality.Conclusions In this large claims-based study,in-hospital mortality,GIH,AKI,tamponade,and pericardiocentesis were higher in older adults compared with younger adults,in a stepwise manner by age group.展开更多
AIM To verify the validity of the endoscopy guidelines for patients taking warfarin or direct oral anticoagulants(DOAC).METHODS We collected data from 218 patients receiving oral anticoagulants(73 DOAC users, 145 warf...AIM To verify the validity of the endoscopy guidelines for patients taking warfarin or direct oral anticoagulants(DOAC).METHODS We collected data from 218 patients receiving oral anticoagulants(73 DOAC users, 145 warfarin users) and 218 patients not receiving any antithrombotics(age-and sexmatched controls) who underwent polypectomy.(1) We evaluated post-polypectomy bleeding(PPB) risk in patients receiving warfarin or DOAC compared with controls;(2) we assessed the risks of PPB and thromboembolism between three AC management methods: Discontinuing AC with heparin bridge(HPB)(endoscopy guideline recommendation), continuing AC, and discontinuing AC without HPB.RESULTS PPB rate was significantly higher in warfarin users and DOAC users compared with controls(13.7% and 13.7% vs 0.9%, P < 0.001), but was not significantly different between rivaroxaban(13.2%), dabigatran(11.1%), and apixaban(13.3%) users. Two thromboembolic events occurred in warfarin users, but none in DOAC users. Compared with the continuing anticoagulant group, the discontinuing anticoagulant with HPB group(guideline recommendation) had a higher PPB rate(10.8% vs 19.6%, P = 0.087). These findings were significantly evident in warfarin but not DOAC users. One thrombotic event occurred in the discontinuing anticoagulant with HPB group and the discontinuing anticoagulant without HPB group; none occurred in the continuing anticoagulant group.CONCLUSION PPB risk was similar between patients taking warfarin and DOAC. Thromboembolism was observed in warfarin users only. The guideline recommendations for HPB should be re-considered.展开更多
文摘Background Coronary atherectomy is used to treat severely calcified coronary artery lesions which are more frequent with increasing age,but its impact in older adults has not been sufficiently examined.Methods We compared adults≥18 years old who underwent coronary atherectomy during inpatient PCI in 2016–2023 from the Vizient Clinical Data Base and compared outcomes in younger(<65 years),youngest-old(65–74 years),middle-old(75–84 years),and oldest-old(≥85 years)adults.Primary outcome was in-hospital mortality,and secondary outcomes included postprocedural complications.Results Among 47,337 patients who underwent coronary atherectomy,19,862(42.0%)were younger adults and 27,475(58.0%)were older adults,including 13,583 youngest-old,10,206 middle-old,and 3,686 oldest-old adults.Compared with younger adults,youngest-old adults had higher mortality(adjusted odds ratio[aOR]=1.37,P<0.001),ischemic stroke(aOR=1.35,P=0.005),gastrointestinal hemorrhage(GIH)(aOR=1.44,P<0.001),acute kidney injury(AKI)(aOR=1.43,P<0.001),tamponade(aOR=1.86,P<0.001),and pericardiocentesis(aOR=2.32,P<0.001).Middle-old adults had higher mortality(aOR=1.80,P<0.001),GIH(aOR=1.42,P=0.002),AKI(aOR=1.63,P<0.001),tamponade(aOR=2.52,P<0.001),and pericardiocentesis(aOR=3.13,P<0.001).Oldest-old adults had the highest odds for mortality(aOR=2.03,P<0.001),GIH(aOR=1.48,P=0.016),AKI(aOR=2.26,P<0.001),tamponade(aOR=3.86,P<0.001),and pericardiocentesis(aOR=4.21,P<0.001).There was a significant interaction(P-interaction=0.035)between atherectomy and age groups with regard to the odds of in-hospital mortality.Conclusions In this large claims-based study,in-hospital mortality,GIH,AKI,tamponade,and pericardiocentesis were higher in older adults compared with younger adults,in a stepwise manner by age group.
基金Supported by Grant--in--Aid for Research from the National Center for Global Health and Medicine(29-2001) partly
文摘AIM To verify the validity of the endoscopy guidelines for patients taking warfarin or direct oral anticoagulants(DOAC).METHODS We collected data from 218 patients receiving oral anticoagulants(73 DOAC users, 145 warfarin users) and 218 patients not receiving any antithrombotics(age-and sexmatched controls) who underwent polypectomy.(1) We evaluated post-polypectomy bleeding(PPB) risk in patients receiving warfarin or DOAC compared with controls;(2) we assessed the risks of PPB and thromboembolism between three AC management methods: Discontinuing AC with heparin bridge(HPB)(endoscopy guideline recommendation), continuing AC, and discontinuing AC without HPB.RESULTS PPB rate was significantly higher in warfarin users and DOAC users compared with controls(13.7% and 13.7% vs 0.9%, P < 0.001), but was not significantly different between rivaroxaban(13.2%), dabigatran(11.1%), and apixaban(13.3%) users. Two thromboembolic events occurred in warfarin users, but none in DOAC users. Compared with the continuing anticoagulant group, the discontinuing anticoagulant with HPB group(guideline recommendation) had a higher PPB rate(10.8% vs 19.6%, P = 0.087). These findings were significantly evident in warfarin but not DOAC users. One thrombotic event occurred in the discontinuing anticoagulant with HPB group and the discontinuing anticoagulant without HPB group; none occurred in the continuing anticoagulant group.CONCLUSION PPB risk was similar between patients taking warfarin and DOAC. Thromboembolism was observed in warfarin users only. The guideline recommendations for HPB should be re-considered.
