Although chest distress is the most frequent complication in the aged
Although chest distress is the most frequent complication in the aged with chronic atrial frbrillation (AF) in clinical practice, you will find few data around the association between chronic AF and coronary artery disease (CAD) in the aged in terms of medical treatment and long-term outcome. AF patients was observed to be markedly less than that of patients with SR (57.33 6.87 mmHg vs 71.08 10.54 mmHg, < 0.01). Compared with SR patients, severe stenosis of the coronary artery in AF patients was reduced (73.06% vs 44.44%, Chi-square test: < 0.01). AF patients with chest distress experienced high CHADS2 score (3.72 1.27), but only 33.3% patients received oral anticoagulants, and such patients experienced a significantly lower rate of revascularization (21.43% vs 55.63%, Chi-square test: < 0.01), and higher rate of all-cause death (22.22% vs 4.38%, Chi-square test: < 0.01) and thromboembolism (16.67% vs 1.68%, Chi-square test: < 0.01) in the long-term follow-ups compared with SR patients. Chest distress in the aged with AF was related to insufficient coronary blood supply that was primarily due to a reduced DBP rather than to occult CAD. Adequate and safe medical therapy was hard to achieve in these patients. Such patients buy 878419-78-4 typically have a poor prognosis, and optimal therapeutic strategies to treat them are urgently needed. values were two-sided, and a value of <0.05 was considered to be statistically significant. Statistical analyses were performed using SPSS (v 18.0; SPSS, Inc, Chicago, IL). Results Patient characteristics This study included 315 patients (312 men and 3 buy 878419-78-4 women) who underwent percutaneous coronary interventions (PCIs) from 1998 to 2009 and experienced detailed clinical records. Among these patients, 297 patients (294 men and three women) experienced an SR. In total, 18 patients (5.71%) with pre-existing AF were identified, in addition to six cases of permanent AF, ten cases of paroxysmal AF, and two cases of persistent AF. Mean age of the AF patients was 79 years (range: 65 to 87 years), and imply duration of AF was 10.21 6.5 years (range: 0.7 to 27 years). The most frequent concomitant disease of AF with chest distress in the aged was heart failure (HF), followed by hypertension and diabetes mellitus (Table 1). Table 1 Baseline characteristics of the study population Average DBP of the investigated AF patients was lower than that of patients with SR (57.33 6.87 mmHg vs 71.08 10.54 mmHg, < 0.01) (Table 2). Table 2 Clinical assessment NEDD4L of elderly patients with chest distress Coronary angiography The angiographic results obtained from elderly patients with AF in comparison with those obtained from patients with SR are shown in Table 3. A narrowing of >75% was present in 44.44% of patients with AF and in 73.06% of patients with SR (Chi-square test: < 0.01; Table 4). Table 3 The number of vessels with coronary disease in elderly patients with chest distress Table 4 Coronary artery stenosis in patients with different heart rhythms Revascularization and antithrombotic therapy SR patients had a significantly higher rate of revascularization than AF patients (55.63% vs 21.43%, = 0.012), 136 (51.12%) received stent, and 12 (4.51%) were treated with a coronary artery bypass graft. Most patients received a drug-eluting stent (DES). Antithrombotic medications in SR patients after stent implantation included lifelong aspirin (ASA) and clopidogrel 75 mg/day for 1 year, with a minimum recommended period of 6 months in the DES and 1 month in the bare metal stent. Moreover, of the 18 patients with AF, seven (38.89%) were treated with both ASA and clopidogrel, five (27.78%) were prescribed a single antiplatelet drug (ASA or clopidogrel), and six (33.33%) received warfarin. buy 878419-78-4 buy 878419-78-4 Influence of CHADS2 score on antithrombotic treatment Based on the presence of concomitant diseases and a history of previous stroke or TIA, the mean CHADS2 score in AF patients was 3.72 1.27. The distribution of the CHADS2 scores in these elderly patients with chest distress was as follows: 16.7% (3/18) = 2, 33.3% (6/18) = 3, 22.2% (4/18).