Online Appendix for the following May 1 JACC article
TITLE: Characteristics, Management, and Outcomes of 5,557 Patients Age ≥90 With
Acute Coronary Syndromes: Results From the CRUSADE Initiative
AUTHORS: Adam H. Skolnick, MD, Cardiovascular Division, Beth Israel
Deaconess Medical Center, Boston, Massachusetts, Karen P. Alexander, MD, Duke
Clinical Research Institute, Duke University Medical Center, Durham, North
Carolina, Anita Y. Chen, MS, Duke Clinical Research Institute, Duke University
Medical Center, Durham, North Carolina, Matthew T. Roe, MD, MSH, Duke Clinical
Research Institute, Duke University Medical Center, Durham, North Carolina,
Charles V. Pollack, Jr., MD, MA, Pennsylvania Hospital, University of Pennsylvania
Health System, Philadelphia, Pennsylvania, E. Magnus Ohman, MD, Duke Clinical
Research Institute, Duke University Medical Center, Durham, North Carolina, John S.
Rumsfeld, MD, PhD, Denver VA Medical Center/University of Colorado, Denver,
Colorado, W. Brian Gibler, MD, University of Cincinnati College of Medicine,
Cincinnati, Ohio, Eric D. Peterson, MD, MPH, Duke Clinical Research Institute,
Duke University Medical Center, Durham, North Carolina, David J. Cohen, MD,
MSc, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston,
Massachusetts, and Saint Luke’s Mid America Heart Institute, Kansas City, Missouri
APPENDIX
The following is a list of contraindications to specific therapies. For aspirin,
contraindications included active bleeding/history of bleeding, ulcer or serious
gastrointestinal or genitourinary bleeding, dyspepsia, platelet count <100,000 mm3,
anemia, and concurrent use of warfarin. Additional contraindications by medication
class were as follows: beta-blockers (bradycardia, heart block greater than first
degree,
cardiogenic
shock,
hypotension,
chronic
disease/asthma/bronchospasm);
glycoprotein
IIb/IIIa
obstructive
inhibitors
pulmonary
(active/recent
bleeding, platelet count <100,000 mm3, severe hypertension, recent major surgery,
recent stroke/any previous hemorrhagic stroke, serum creatinine >4.0 mg/dl, severe
comorbid illness); heparin (active/recent bleeding, platelet count <100,000 mm3, ulcer
or serious gastrointestinal or genitourinary bleeding, history of known heparininduced thrombocytopenia, severe comorbid illness); lipid-lowering agents (hepatic
or renal dysfunction, abnormal liver function tests, primary biliary cirrhosis);
angiotensin-converting enzyme inhibitors (history of angioedema, impaired renal
function, hypotension, hyperkalemia, pregnancy, liver disease). Contraindications to
percutaneous coronary intervention or coronary artery bypass grafting included active
bleeding on arrival or within 24 h, history of stroke, recent surgery or trauma,
intracranial neoplasm/AV malformation/aneurysm, severe uncontrolled hypertension,
diagnosis unclear, prior allergy to intravenous contrast, suspected aortic dissection,
active peptic ulcer disease, quality-of-life decision, comorbid disease, unsuitable
anatomy, or DNR status. Additionally, a category for “other contraindication” was
available to allow for provider discretion in determining eligibility for treatment.