A Series Of Clinical Studies On Factors Associated With Poor Prognosis In Elderly Patients With Acute Myocardial Infarction

Background and aim:Elevated C-reactive protein(CRP)and low body mass index(BMI)associated with increased mortality in elderly patients.Yet,their combined value for predicting the cardiovascular(CV)outcomes remains undetermined among the oldest-old(?80yrs)with acute myocardial infarction(AMI).Methods:A total of 1,140 patients with AMI aged 80 years and older were enrolled between January 2012 and June 2017.A nested case-control study was implemented in 106 deaths and 212 controls matched for age,sex,the time of inclusion,and infarction type.The additive values of hsCRP and BMI were evaluated by unadjusted Kaplan Meier analysis,adjusted hazard ratio,and receiver operating characteristic curve models.Results:Median follow-up was 19.15 months with 106 deaths(33.3%).HsCRP,BMI,and LVEF were significantly associated with all-cause mortality(p<0.05,respectively).Besides,a negative association of BMI[hazard ratio(HR)0.935,95%confidence interval(CI)0.884-0.988]and LVEF(HR:0.973,95%CI:0.954-0.993)with all-cause mortality in fully adjusted Cox proportional hazards model and a positive association of hsCRP with these outcome(HR 1.043,95%CI 1.002-1.087)were detected in the present study.A combined detection of hsCRP,BMI,and LVEF with traditional CV risk factors was found to be enhanced predicting value for all-cause mortality(0.733 in jointly vs.0.623 in CV risk factors,p=0.0007).Conclusions:HsCRP,BMI,and LVEF are the independent risk factors for all-cause mortality among the oldest-old patients with AMI,which are more relevant and greatly be improved by combined use of these indexes compared with traditional risk factors.Background and aim:Compared with what is known about the prognostic value of lipoprotein(a)[Lp(a)]in middle-aged patients with atherosclerotic cardiovascular disease(ASCVD),less is understood concerning the role of Lp(a)in oldest-old(?80 years old)with ASCVD.The aim of the present study was to investigate the relationship between Lp(a)and cardiovascular death among the oldest-old with acute myocardial infarction(AMI).Methods:A total of 1008 patients with AMI older than 80 years were consecutively enrolled between January 2012 and August 2018.The clinical characteristics were collected and Lp(a)concentrations were measured by immunoturbidimetric method at baseline.The relationship between plasma Lp(a)concentration(?10mg/dL,10-30mg/dL,>30mg/dL)and cardiovascular death was evaluated by Kaplan-Meier analysis and Cox proportional hazard models.Results:During an average of 36.26 months follow-up,287 cardiovascular death occurred.Data showed that patients with high Lp(a)levels(>30mg/dL)had the highest rate of cardiovascular death(p<0.05).Kaplan-Meier analysis showed that high Lp(a)group had the lowest event-free survival rate in the oldest-old with AMI(p=0.030).In addition,subjects with Lp(a)>30mg/dL had a 1.5-fold(95%confidence interval:1.044-2.080)higher risk of cardiovascular death compared with those with Lp(a)<10mg/dL in fully adjusted Cox proportional hazards model.Conclusions:The current data firstly showed that plasma Lp(a)concentration was associated with the risk of cardiovascular death in oldest-old with AMI,suggesting that the Lp(a)could be a useful adjunctive measurement in the evaluation of cardiovascular death in these population.Background and aim:Numerous trials in middle-aged adults enrolling participants 60 years and over have shown that lowering BP reduces death and cardiovascular disease(CVD)risk,yet understanding about the relationship between diastolic blood pressure(DBP)and cardiovascular death in oldest-old(?80 years old)at high-CVD risk is very limited.The aim of the present study was to explore the prognostic value of DBP for cardiovascular death and its optimal level during the first 48 hours after admission for acute myocardial infarction(AMI)among the oldest-old.Methods and results:A total of 1,005 patients with AMI older than 80 years were consecutively enrolled between January 2012 and August 2018.Average diastolic blood pressure(aDBP)values over the first 48 hours after admission were recorded,and the population was dichotomized into 2 groups:low aDBP group(<65.5 mm Hg)and control group(aDBP?65.5 mm Hg).Comparing with patients without cardiovascular death at 2.9-year follow-up,patients who died from a cardiovascular cause had higher rate of cardiovascular risks factors,including age,diabetes mellitus,and cardiovascular history,but they were more likely to have a low body mass index.Patients with aDBP<65.5 mm Hg had a 1.5-fold risk of 2.9-year cardiovascular death(35.9%versus 24.0%;P<0.001).By multivariable logistic regression analysis,low aDBP(odds ratio[95%CI],1.92[1.24-2.97])remained a strong and independent predictor of 2.9-year cardiovascular death.Conclusions:The current data firstly showed that in oldest-old patients with AMI,low aDBP was an independent and powerful predictor of 2.9-year cardiovascular death.Early aDBP measurement could help to improve risk stratification.Moreover,this finding may suggest an optimal blood pressure target in elderly patients.