Key result
Complete revascularization linked to ~37% lower MACE risk vs incomplete revascularization in ACS patients >75.
Why the study?
The prognostic benefit of complete revascularization in patients aged over 75 years with multi-vessel disease and ACS is currently unclear.
Does complete revascularization reduce MACE in elderly patients (aged over 75 years) with multi-vessel disease and acute coronary syndrome?
Observational (n=1,263)
Yes
Does complete revascularization reduce MACE in elderly patients (aged over 75 years) with multi-vessel disease and acute coronary syndrome?
In ACS patients over 75 years old with multi-vessel disease, complete revascularization is associated with a significantly lower risk of MACE at one year compared to incomplete revascularization.
Answers are grounded in this paper and cite their sources.
Supports complete revascularization in elderly multivessel ACS; extends evidence to patients >75 years.
BACKGROUND The prognostic benefit of complete revascularization in elderly patients (aged over 75 years) with multi-vessel disease and acute coronary syndrome (ACS) is currently unclear. This study aimed to determine the long-term prognostic impact of complete revascularization in this population. METHODS We conducted this study using data obtained from the BleeMACS (Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome) registry, which was carried out from 2003 to 2014. The objective was to categorize older patients diagnosed with ACS into two groups: those who underwent complete revascularization and those who did not. Propensity score matching and the Kaplan-Meier analysis were employed to examine differences in one-year clinical outcomes. The primary endpoint was major adverse cardiovascular event (MACE), which encompassed a combination of all-cause mortality and myocardial infarction. RESULTS Out of 1263 patients evaluated, 445 patients (35.2%) received complete revascularization. Patients who underwent complete revascularization had a higher prevalence of hypertension and prior percutaneous coronary intervention compared to those who did not. During the one-year follow-up period, complete revascularization was associated with a significantly decreased risk of MACE [13.7% vs. 20.5%, hazard ratio (HR) = 0.63, 95% CI: 0.45–0.88, P = 0.007] and a lower risk of myocardial infarction (5.9% vs. 9.9%, HR = 0.55, 95% CI: 0.33–0.92, P = 0.02). However, it was not linked to a lower risk of all-cause death (9.5% vs. 13.5%, HR = 0.68, 95% CI: 0.45–1.02, P = 0.06). Similar results were observed in the subgroup analysis. CONCLUSIONS Long-term clinical improvements were observed in ACS patients aged over 75 years with multi-vessel disease who achieved complete revascularization. Therefore, adhering to guidelines for complete revascularization should be recommended for elderly patients.
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Wang et al. (2023) conducted an observational in Acute coronary syndrome and multi-vessel disease (n=1,263). Complete revascularization vs. No complete revascularization was evaluated on Major adverse cardiovascular event (MACE), encompassing all-cause mortality and myocardial infarction (HR 0.63, 95% CI 0.45-0.88, p=0.007). Complete revascularization in ACS patients >75 years with multi-vessel disease significantly reduced the risk of MACE compared to incomplete revascularization (HR 0.63; 95% CI 0.45-0.88; P=0.007).
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