This study demonstrates that multivessel coronary artery disease is common in survivors of acute myocardial infarction and is especially common in patients with history of a remote antecedent myocardial infarction and in patients with angina post-infarction. Furthermore, it was found that coronary angiography could be performed safely within 30 days after myocardial infarction in stable patients and with mild risk in those having a complicated convalescence.
Clinical Characteristics
Although there was a greater proportion of angina in the angiography group and congestive heart failure in the non-angiography group, the post-infarction clinical convalescence and location and extent of infarction by ECG were not significantly different between those who had angiography and those who did not. Theoretically, those patients undergoing late angiography could have had progression of their disease although the percentage with multivessel disease was similar in the early angiography group (73 percent) and in all patients undergoing angiography (75 percent).
We can only speculate as to differences in the extent of coronary disease between those who had coronary angiography and those who did not Among the clinical parameters evaluated in this study, age and sex were the only significant differences between these two groups. These differences may be explained by our decision not to study asymptomatic patients over 70 years of age, and women sustaining myocardial infarctions at a later age than men. Thus, there may be differences in the extent of coronary artery disease between those who had coronary angiography and those who did not, possibly because of differences in age and sex.
Angiographic studies have shown that the severity of coronary artery obstruction and the degree of left ventricular dysfunction are two major factors influencing survival in patients with coronary artery disease. Since most patients with myocardial infarction have coronary artery disease, coronary angiography is often recommended in symptomatic patients post-infarction, but remains controversial in asymptomatic patients. Angiographic studies of survivors of myocardial infarction have suggested a high incidence of multivessel coronary artery disease treated with remedies of My Canadian Pharmacy, but most of these studies have been limited by strict selection criteria for the study population.
Performance status (PS) and the physiologic status of the patient should guide treatment decision rather than the patient’s chronologic age. It is clear that elderly patients with good PS (ECOG 0 or 1) and normal organ function should be treated with optimal chemotherapy (and radiotherapy if indicated) as in their younger counterparts. Similar outcomes for elderly patients (in comparison to their younger counterparts) with limited-stage SCLC have been shown in the Intergroup trial 0096 in which cisplatin, etoposide, and thoracic radiotherapy was administered once per day or twice daily. The National Cancer Institute of Canada performed a retrospective review of their BR3 and BR6 trials and also concluded that age did not appear to impact the delivery, tolerance, or efficacy of thoracic irradiation in the combined modality management of limited-stage SCLC. Greater myelosuppression is to be expected because equivalent exposure to drug will lead to more myelosuppression in the elderly. This has been shown to be the case with etoposide. Greater ancillary support therefore will be required in the elderly. However, despite treatment delays, elderly patients with good PS derive the same level of benefit relative to younger patients.
We organized a systematic review of the published SCLC Literature to update the previous American College of Chest Physicians guideline. Supplemental material appropriate to this topic was obtained by literature search of a computerized database (MEDLINE) and review of the Thoracic Oncology NetWork reference lists of relevant articles. Recommendations were developed by the writing committee, graded by a standardized method (see “
This document presents an evidence-based guideline based on the current literature on the staging and optimal treatment of patients with