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• W3083879599 abstract "El objetivo es evaluar la interacción entre carga de comorbilidad y beneficio de la revascularización en ancianos con síndrome coronario agudo sin elevación del ST (SCASEST). Estudio retrospectivo que incluyó a 7.211 pacientes de edad ≥ 70 años y procedentes de 11 registros de SCASEST españoles. Se evaluaron 6 comorbilidades (diabetes mellitus, arteriopatía periférica, enfermedad cerebrovascular, enfermedad pulmonar crónica, insuficiencia renal y anemia). Se calculó una puntuación de propensión para comparar el efecto de la revascularización frente al tratamiento conservador. El objetivo fue la mortalidad a 1 año. Al año habían fallecido 1.090 pacientes (15%). La frecuencia de revascularización durante la hospitalización fue del 60%. La revascularización se asoció con menor mortalidad, cuya magnitud no cambió al añadir al modelo las comorbilidades (HR = 0,61; IC95%, 0,53-0,69; p = 0,0001). Sin embargo, los efectos de la revascularización se atenuaron en los pacientes con insuficiencia renal, arteriopatía periférica y enfermedad pulmonar crónica (para la interacción, p = 0,004, p = 0,007 y p = 0,03 respectivamente), mientras que no se modificaron con la diabetes mellitus, la anemia o la enfermedad cerebrovascular (p = 0,74, p = 0,51 y p = 0,28). Los beneficios de la revascularización disminuyeron gradualmente según aumentaba el número de comorbilidades (de HR = 0,48; IC95%, 0,39-0,61 con 0 comorbilidades hasta HR = 0,83; IC95%, 0,62-1,12 con 5 o más comorbilidades; omnibus, p = 0,016). Los resultados fueron idénticos con el modelo de la puntuación de propensión o cuando se utilizó la intervención de cateterismo cardiaco como variable de exposición. La revascularización durante el ingreso mejoró independientemente de las comorbilidades la mortalidad a 1 año de una población anciana con SCASEST. No obstante, el beneficio se redujo de manera progresiva según aumentaba la carga de comorbilidades. La insuficiencia renal, la arteriopatía periférica y la enfermedad pulmonar crónica son las comorbilidades que más contrarrestaron los potenciales beneficios de la revascularización. To evaluate the interaction between comorbidity burden and the benefits of in-hospital revascularization in elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS). This retrospective study included 7211 patients aged ≥ 70 years from 11 Spanish NSTEACS registries. Six comorbidities were evaluated: diabetes, peripheral artery disease, cerebrovascular disease, chronic pulmonary disease, renal failure, and anemia. A propensity score was estimated to enable an adjusted comparison of in-hospital revascularization and conservative management. The end point was 1-year all-cause mortality. In total, 1090 patients (15%) died. The in-hospital revascularization rate was 60%. Revascularization was associated with lower 1-year mortality; the strength of the association was unchanged by the addition of comorbidities to the model (HR, 0.61; 95%CI, 0.53-0.69; P = .0001). However, the effects of revascularization were attenuated in patients with renal failure, peripheral artery disease, and chronic pulmonary disease (P for interaction = .004, .007, and .03, respectively) but were not modified by diabetes, anemia, and previous stroke (P = .74, .51, and .28, respectively). Revascularization benefits gradually decreased as the number of comorbidities increased (from a HR of 0.48 [95%CI, 0.39-0.61] with 0 comorbidities to 0.83 [95%CI, 0.62-1.12] with ≥ 5 comorbidities; omnibus P = .016). The results were similar for the propensity score model. The same findings were obtained when invasive management was considered the exposure variable. In-hospital revascularization improves 1-year mortality regardless of comorbidities in elderly patients with NSTEACS. However, the revascularization benefit is progressively reduced with an increased comorbidity burden. Renal failure, peripheral artery disease, and chronic lung disease were the comorbidities with the most detrimental effects on revascularization benefits." @default.
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• W3083879599 date "2021-09-01" @default.
• W3083879599 modified "2023-10-17" @default.
• W3083879599 title "Carga de comorbilidad y beneficio de la revascularización en ancianos con síndrome coronario agudo" @default.
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• W3083879599 doi "https://doi.org/10.1016/j.recesp.2020.06.025" @default.
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