April 12, 2024BMC GeriatricsOpen Access

Predictors of major adverse cardiac and cerebrovascular events after percutaneous coronary intervention in older adults: a systematic review and meta-analysis

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Why the study?

The study was conducted to systematically review and meta-analyze the predictors of major adverse cardiac and cerebrovascular events in older adults undergoing PCI.

Structured PICO

Population

34 observational studies pooling 25,550 adults ≥ 60 years old with coronary artery disease (acute or chronic) who underwent percutaneous coronary intervention (PCI).

Intervention

Percutaneous coronary intervention (PCI)

Outcome

Out-of-hospital major adverse cardiac and cerebrovascular events (MACE/MACCE)composite

In older adults undergoing PCI, clinical factors such as diabetes, prior MI, STEMI presentation, reduced LVEF, and LMCA disease are strong predictors of subsequent MACE/MACCE.

Limitations

Considered studies that reported multiple predictors of MACE/MACCE in their multivariate analysis rather than a single exposure
Meta-analyses were performed using HRs resulting from a multivariate model; some studies did not use multivariate analysis or report effect sizes for statistically non-significant variables
Some studies misreported the OR instead of the HR
Significant heterogeneity mainly due to differences in endpoint definitions (MACE/MACCE) and population

Implication

Supports risk stratification in older PCI patients; leaves open prospective validation in randomized cohorts.

Abstract

AIM: We systematically reviewed and meta-analyzed the predictors of major adverse cardiac and cerebrovascular events (MACE/MACCE) in older adults who underwent PCI. METHODS: Three databases, PubMed, Embase, and Scopus, were searched for observational studies considering the out-of-hospital MACE/MACCE in adults ≥ 60 years old with coronary artery disease (acute or chronic) who underwent PCI. Studies were eligible if they had determined at least two statistically significant predictors of MACE/MACCE by multivariable analysis. We used the QUIPS tool to evaluate the risk of bias in the studies. Random-effects meta-analysis was utilized to pool the hazard ratios (HRs) of the most reported predictors. RESULTS: A total of 34 studies were included in the review. Older age (HR = 1.04, 95% Confidence Interval (CI): 1.03-1.06, P-value < 0.001), diabetes (HR = 1.36, 95% CI: 1.22-1.53, P < 0.001), history of myocardial infarction (MI) (HR = 1.88, 95% CI: 1.37-2.57, P < 0.001), ST-elevation MI (STEMI) at presentation (HR = 1.72, 95% CI: 1.37-2.18, P < 0.001), reduced left ventricular ejection fraction (LVEF) (HR = 2.01, 95% CI: 1.52-2.65, P < 0.001), successful PCI (HR = 0.35, 95% CI: 0.27-0.47, P < 0.001), eGFR (HR = 0.99, 95% CI: 0.97-1.00; P-value = 0.04) and left main coronary artery (LMCA) disease (HR = 2.07, 95% CI: 1.52-2.84, P < 0.001) were identified as predictors of MACE. CONCLUSION: We identified older age, diabetes, history of MI, STEMI presentation, lower LVEF, and LMCA disease increased the risk of MACE/MACCE after PCI in older adults. Meanwhile, higher eGFR and successful PCI predicted lower adverse events risk. Future studies should focus on a more robust methodology and a precise definition of MACE. REGISTRATION: PROSPERO (CRD42023480332).