Background Radial artery access for coronary procedures is a safe and beneficial technique. However, elderly patients have been considered as a higher risk group of access site related complications compared to younge...Background Radial artery access for coronary procedures is a safe and beneficial technique. However, elderly patients have been considered as a higher risk group of access site related complications compared to younger patients. This study was conducted to investigate the feasibility and safety oftransradial coronary angiography or intervention in the elderly. Methods A total of 6132 patients from Korean Transradial Intervention Prospective Registry at 20 centers were analyzed. Patients were divided into the non-elderly group （n = 5667） and the elderly （_〉 80 years） group （n = 465）. Using propensity score matching, the elderly group （n = 465） was compared with one-to-one matched the non-elderly group （n = 465）. Results After propensity score matching, mean age was 64.3 ＋ 10.3 years in the non-elderly group and 83.5 -4- 3.3 years in the elderly group. There was no difference of procedural characteristics, procedural and fluoroscopic times. Access site cross-over rate was not different between the non-elderly group and elderly group （7.5% vs. 6.2%, P = 0.074）. Bleeding compli- cations occurred similarly in two groups （2.6% of the non-elderly group vs. 1.9% of the elderly group, P -~ 0.660）. Access site complications were 1.9% of the non-elderly group and 0.9% of the elderly group （P = 0.263）. Both of in hospital death and cardiovascular death for one year were also similar between two groups. Conclusions Transradial angiography or intervention was safe and feasible in elderly patients. Complication rates and clinical outcomes in elderly patients were comparable with those in non-elderly patients.展开更多
Ostial lesions present many challenges for percutaneous coronary intervention （PCI）. Coronary anomaly will further increase difficulties in performing PCI for the patient. We present such a case as ostial occlusion ...Ostial lesions present many challenges for percutaneous coronary intervention （PCI）. Coronary anomaly will further increase difficulties in performing PCI for the patient. We present such a case as ostial occlusion of an right coronary artery with high takeoff. A 77-year-old male was referred to our institution with a diagnosis of non-ST elevated acute myocardial infarction. Selective coronary angiography and nonselective ascending aortography could not identify the origin of the right coronary artery. Multi-slices computed tomography showed RCA ostial totally occluded. A successful PCI was performed and a perfect final result was achieved utilized with many tips and tricks, including buddy wtre technique and focused-force angloplasty（J Genatr Cardio12009, 6：189-192）.展开更多
Background The influence of homocysteine （Hcy） on the migration and proliferation of vascular smooth muscle cells has been well established. However, the impact of Hcy levels on the progression of non-culprit corona...Background The influence of homocysteine （Hcy） on the migration and proliferation of vascular smooth muscle cells has been well established. However, the impact of Hcy levels on the progression of non-culprit coronary lesions （NCCLs） is controversial. This study aims to evaluate whether the plasma level of Hcy is related to the progression of NCCLs after percutaneous coronary stent implantation in elderly patients with acute coronary syndrome （ACS）. Methods A total of 223 elderly patients （〉 65 years old） with ACS undergoing stent im- plantation and follow-up coronary angiography were enrolled. Laboratory determination comprised of blood sample evaluation for Hcy was carried out before baseline coronary intervention. The patients were classified into two groups according to the blood Hcy tertiles （〉 15 mmol/L or 〈 15 mmol/L）. Patients were followed up for 12.2 months. NCCL progression was assessed by three-dimensional quantitative coronary angiography. Results A significantly higher ratio of NCCL progression was observed in the group with baseline Hcy concentrations above 15 mmol/L compared to the group with concentrations below 15 mmol/L （41/127, 32.3% vs. 14/96, 14.6%, P = 0.002）. Multivariate Cox regression analysis showed that Hcy and diabetes mellitus were independent risk factors for NCCL progression. The crude haz- ard ratio （HR） of NCCL progression for Hcy level was 1.056 （95% CI： 1.01-1.104, P = 0.015）. The adjusted HR of NCCL progression for Hcy level was 1.024 （95% CI： 1.007-1.042, P = 0.007）. The adjusted HR of NCCL progression for diabetes mellitus was 1.992 （95% CI： 1.15-3.44, P = 0.013）. Conclusions Hcy is an independent risk factor for NCCL progression after 12 months of follow-up in elderly patients with ACS who has undergone percutaneous coronary stenting.展开更多
Objective To assess whether the low-density lipoprotein cholesterol （LDL-C） target value and preventive effect of statins are different between elderly and younger patients. Methods We investigated 304 patients with...Objective To assess whether the low-density lipoprotein cholesterol （LDL-C） target value and preventive effect of statins are different between elderly and younger patients. Methods We investigated 304 patients with previous percutaneous coronary intervention who underwent coronary angiography from January 2007 to December 2016 for examination of recurrent ischemia beyond the early restenosis. Patients were classified into two groups： age ≥ 75 years （elderly group： n = 140） and 〈 75 years （younger group： n = 164）. Relationships between the achieved LDL-C level, incidence of late coronary events, and the effectiveness of statins were evaluated. Results During follow-up, 179 patients underwent late coronary revascularization. Recurrent ischemia presenting as acute coronary syndrome （ACS） occurred in 83 cases. Kaplan-Meier curve analysis revealed that in the younger group, recurrent ACS was significantly lower in patients with LDL-C 〈 70 mg/dL than in those with LDL-C ranging from 70 to 〈 100 mg/dL （P = 0.035）; however, there was no difference between these in the elderly group （P = 0.863）. Instead, recurrent ACS was less frequent in patients with LDL-C ranging from 70 mg/dL to 〈 100 mg/dL than in those with LDL-C ≥ 100 mg/dL in the elderly group （v = 0.033）. Statin use was associated with decreased recurrent ACS （P = 0.005）; moreover, only using statins was an independent predictor in the elderly group （HR： 0.375; P = 0.007）. Conclusions Strict control of LDL-C to 〈 70 mg/dL was effective for reducing the incidence of recurrent ACS in younger patients. However, LDL-C 〈 100 mg/dL might be sufficient as the target value of LDL-C-lowering therapy for secondary prevention of ischemic events in Japanese elderly patients.展开更多
文摘Background Radial artery access for coronary procedures is a safe and beneficial technique. However, elderly patients have been considered as a higher risk group of access site related complications compared to younger patients. This study was conducted to investigate the feasibility and safety oftransradial coronary angiography or intervention in the elderly. Methods A total of 6132 patients from Korean Transradial Intervention Prospective Registry at 20 centers were analyzed. Patients were divided into the non-elderly group （n = 5667） and the elderly （_〉 80 years） group （n = 465）. Using propensity score matching, the elderly group （n = 465） was compared with one-to-one matched the non-elderly group （n = 465）. Results After propensity score matching, mean age was 64.3 ＋ 10.3 years in the non-elderly group and 83.5 -4- 3.3 years in the elderly group. There was no difference of procedural characteristics, procedural and fluoroscopic times. Access site cross-over rate was not different between the non-elderly group and elderly group （7.5% vs. 6.2%, P = 0.074）. Bleeding compli- cations occurred similarly in two groups （2.6% of the non-elderly group vs. 1.9% of the elderly group, P -~ 0.660）. Access site complications were 1.9% of the non-elderly group and 0.9% of the elderly group （P = 0.263）. Both of in hospital death and cardiovascular death for one year were also similar between two groups. Conclusions Transradial angiography or intervention was safe and feasible in elderly patients. Complication rates and clinical outcomes in elderly patients were comparable with those in non-elderly patients.
文摘Ostial lesions present many challenges for percutaneous coronary intervention （PCI）. Coronary anomaly will further increase difficulties in performing PCI for the patient. We present such a case as ostial occlusion of an right coronary artery with high takeoff. A 77-year-old male was referred to our institution with a diagnosis of non-ST elevated acute myocardial infarction. Selective coronary angiography and nonselective ascending aortography could not identify the origin of the right coronary artery. Multi-slices computed tomography showed RCA ostial totally occluded. A successful PCI was performed and a perfect final result was achieved utilized with many tips and tricks, including buddy wtre technique and focused-force angloplasty（J Genatr Cardio12009, 6：189-192）.
文摘Background The influence of homocysteine （Hcy） on the migration and proliferation of vascular smooth muscle cells has been well established. However, the impact of Hcy levels on the progression of non-culprit coronary lesions （NCCLs） is controversial. This study aims to evaluate whether the plasma level of Hcy is related to the progression of NCCLs after percutaneous coronary stent implantation in elderly patients with acute coronary syndrome （ACS）. Methods A total of 223 elderly patients （〉 65 years old） with ACS undergoing stent im- plantation and follow-up coronary angiography were enrolled. Laboratory determination comprised of blood sample evaluation for Hcy was carried out before baseline coronary intervention. The patients were classified into two groups according to the blood Hcy tertiles （〉 15 mmol/L or 〈 15 mmol/L）. Patients were followed up for 12.2 months. NCCL progression was assessed by three-dimensional quantitative coronary angiography. Results A significantly higher ratio of NCCL progression was observed in the group with baseline Hcy concentrations above 15 mmol/L compared to the group with concentrations below 15 mmol/L （41/127, 32.3% vs. 14/96, 14.6%, P = 0.002）. Multivariate Cox regression analysis showed that Hcy and diabetes mellitus were independent risk factors for NCCL progression. The crude haz- ard ratio （HR） of NCCL progression for Hcy level was 1.056 （95% CI： 1.01-1.104, P = 0.015）. The adjusted HR of NCCL progression for Hcy level was 1.024 （95% CI： 1.007-1.042, P = 0.007）. The adjusted HR of NCCL progression for diabetes mellitus was 1.992 （95% CI： 1.15-3.44, P = 0.013）. Conclusions Hcy is an independent risk factor for NCCL progression after 12 months of follow-up in elderly patients with ACS who has undergone percutaneous coronary stenting.
文摘Objective To assess whether the low-density lipoprotein cholesterol （LDL-C） target value and preventive effect of statins are different between elderly and younger patients. Methods We investigated 304 patients with previous percutaneous coronary intervention who underwent coronary angiography from January 2007 to December 2016 for examination of recurrent ischemia beyond the early restenosis. Patients were classified into two groups： age ≥ 75 years （elderly group： n = 140） and 〈 75 years （younger group： n = 164）. Relationships between the achieved LDL-C level, incidence of late coronary events, and the effectiveness of statins were evaluated. Results During follow-up, 179 patients underwent late coronary revascularization. Recurrent ischemia presenting as acute coronary syndrome （ACS） occurred in 83 cases. Kaplan-Meier curve analysis revealed that in the younger group, recurrent ACS was significantly lower in patients with LDL-C 〈 70 mg/dL than in those with LDL-C ranging from 70 to 〈 100 mg/dL （P = 0.035）; however, there was no difference between these in the elderly group （P = 0.863）. Instead, recurrent ACS was less frequent in patients with LDL-C ranging from 70 mg/dL to 〈 100 mg/dL than in those with LDL-C ≥ 100 mg/dL in the elderly group （v = 0.033）. Statin use was associated with decreased recurrent ACS （P = 0.005）; moreover, only using statins was an independent predictor in the elderly group （HR： 0.375; P = 0.007）. Conclusions Strict control of LDL-C to 〈 70 mg/dL was effective for reducing the incidence of recurrent ACS in younger patients. However, LDL-C 〈 100 mg/dL might be sufficient as the target value of LDL-C-lowering therapy for secondary prevention of ischemic events in Japanese elderly patients.
