Non-ST elevation acute coronary syndrome in patients aged 80 years or older in Vietnam: An observational study

Tan Van Nguyen; Khai Xuan Bui; Khuong Dang Tran; Duong Le; Tu Ngoc Nguyen

doi:10.1371/journal.pone.0233272

Peer Review History

Original SubmissionNovember 25, 2019
16 Apr 2020 Decision Letter - Chiara Lazzeri, Editor PONE-D-19-32737 Non-ST elevation acute coronary syndrome in patients aged 80 years or older in Vietnam: an observational study PLOS ONE Dear Dr Nguyen, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. We would appreciate receiving your revised manuscript by May 31 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. 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Please ensure that you refer to Figure 2 in your text as, if accepted, production will need this reference to link the reader to the figure. 2. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Interesting paper entitled "Non-ST elevation acute coronary syndrome in patients aged 80 years or older in Vietnam: an observational study" where the authors state that sample size was not calculated as major limitation. This element limits unfortunately any interpretation of the data collected Reviewer #2: This paper by Tan Van Nguyen et al. was aimed to assess the impact of PCI in ACS patients aged > 80ys. This was a non randomized prospective study enrolling 120 patients, among those 42 participants (35.0%) were treated with invasive strategy. At three months follow up patients who received PCI had significantly lower rates of adverse outcomes. This study has several limitations: - The sample size is quite small to assess hard end points (mortality and cardiovascular events) - The authors did not mention the reason why patients were treated with invasive or medical treatment - Baseline condition of patient treated with PCI or medical therapy were different, with better status of patient treated with PCI - It is already known that older patients with ACS treated with invasive strategy may benefit even more that young patients from guidelines indicated PCI. I believe the authors should focus more on the novelty of implementing a national system for invasive treatment of ACS also in mid- low income countries. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review?** For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0233272.r001
Revision 1
18 Apr 2020 Author Response 18th April 2020 To Dr Chiara Lazzeri Academic Editor, PLOS ONE RE: RESPONSE TO REVIEWERS COMMENTS ON MANUSCRIPT ID PONE-D-19-32737 We would like to thank the reviewers for the time spent reviewing our manuscript and for the useful comments, and to thank the editors for the opportunity to respond. We feel that the suggestions have strengthened the manuscript and have tried to address as many of the suggestions as possible as detailed below. We would be happy to address any further issues if required. Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Partly Reviewer #2: Yes 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: Yes 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Interesting paper entitled "Non-ST elevation acute coronary syndrome in patients aged 80 years or older in Vietnam: an observational study" where the authors state that sample size was not calculated as major limitation. This element limits unfortunately any interpretation of the data collected Response: We have added our justification for sample size. Please see lines 105-110: “Sample size considerations: We estimated our study sample size based on the result of a study conducted in a cohort of elderly patients with ACS in Sweden.14 In that study in 491 patients (mean age 83), the mortality rate after 1 year was 13% in the PCI group and 39.3% in the non-PCI group. Sample size calculations indicated that at least 43 participants would be needed in each group to detect the difference in mortality rate (at the power of 80% and p=0.05).” Reviewer #2: This paper by Tan Van Nguyen et al. was aimed to assess the impact of PCI in ACS patients aged > 80ys. This was a non randomized prospective study enrolling 120 patients, among those 42 participants (35.0%) were treated with invasive strategy. At three months follow up patients who received PCI had significantly lower rates of adverse outcomes. This study has several limitations: - The sample size is quite small to assess hard end points (mortality and cardiovascular events) Response: We have added our justification for sample size. Please see lines 105-110. - The authors did not mention the reason why patients were treated with invasive or medical treatment. Response: We have added the information for PCI decision in patients with non-ST elevation ACS as follows: (please see lines 59-63) “According to the 2018 ESC/EACTS Guidelines on myocardial revascularization, the decision-making process of PCI for non-ST elevation ACS depends on many factors, including clinical presentation, comorbidities, risk stratification, and other features such as estimated life expectancy, the functional and anatomical severity of the coronary arteries” - Baseline condition of patient treated with PCI or medical therapy were different, with better status of patient treated with PCI Response: There was no significant difference in age, sex, and the presence of multimorbidity between patients who did and did not receive PCI. Patients with PCI had higher prevalence of hypertension, lower prevalence of heart failure, lower GRACE score and lower serum creatinine level. As patients treated with PCI had slightly better status, we did examine the influence of these factors in univariate and multivariate survival analysis. (Please see Table 5) - It is already known that older patients with ACS treated with invasive strategy may benefit even more that young patients from guidelines indicated PCI. I believe the authors should focus more on the novelty of implementing a national system for invasive treatment of ACS also in mid- low income countries. Response: Thank you for your suggestion. We have added a section of implications as follows (please see lines 223-239): “Implications for research and clinical practice The clinical evidence for treatment of ACS in the elderly is less robust than in younger patients and in fact, there is no specific guidelines for the management of ACS in general and non-ST elevation ACS in particular in patients aged 80 years or older. In elderly patients, non-ST elevation ACS is more common than STEMI.24 In Vietnam, there has been limited evidence on the epidemiology and treatment of non-ST elevation ACS in patients aged 80 years or older. This study suggests further research on this topic in Vietnam. Most of older people in Vietnam (around 73%) are living in rural areas, where most hospitals do not have interventional facilities.25 Evidence from large international cohort studies showed that the availability of interventional facilities at the admitting hospital is a major predictor of cardiac catheterization and PCI procedure. 26,27 While the recognition and treatment for STEMI is more straightforward, non-ST ACS may be more likely to be under-evaluated and under-treated, especially in rural settings. The findings from this study also suggest that there is a need to increase awareness about the benefits of PCI for patients aged 80 years or older with non-ST elevation ACS in Vietnam, especially in rural clinical settings, and to develop strategies to ensure that elderly patients with non-ST elevation ACS who are candidates for PCI should be promptly referred to hospitals with interventional facilities. ” 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No Reviewer #2: No Journal Requirements: When submitting your revision, we need you to address these additional requirements. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 1. Please ensure that you refer to Figure 2 in your text as, if accepted, production will need this reference to link the reader to the figure. Response: We have added the reference linked to Figure 2 in the main text (Please see line 148) 2. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: https://protect-au.mimecast.com/s/U67cCwV1vMfP99JvH1Sq19?domain=journals.plos.org. Response: We have added the caption (Please see line 260) Attachments Attachment Submitted filename: Authors Responses.docx https://doi.org/10.1371/journal.pone.0233272.r002
4 May 2020 Decision Letter - Chiara Lazzeri, Editor Non-ST elevation acute coronary syndrome in patients aged 80 years or older in Vietnam: an observational study PONE-D-19-32737R1 Dear Dr. Nguyen, We are pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it complies with all outstanding technical requirements. Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and be scheduled for publication. Shortly after the formal acceptance letter is sent, an invoice for payment will follow. To ensure an efficient production and billing process, please log into Editorial Manager at https://www.editorialmanager.com/pone/, click the "Update My Information" link at the top of the page, and update your user information. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. With kind regards, Chiara Lazzeri Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0233272.r003
Formally Accepted
2 Jun 2020 Acceptance Letter - Chiara Lazzeri, Editor PONE-D-19-32737R1 Non-ST elevation acute coronary syndrome in patients aged 80 years or older in Vietnam: an observational study Dear Dr. Nguyen: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Chiara Lazzeri Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0233272.r004

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