Key result
Complete revascularization reduced the risk of major adverse cardiovascular events compared to incomplete revascularization in patients over 70 years old with myocardial infarction (HR 0.82).
Why the study?
The effectiveness of complete versus incomplete revascularization regarding MACE, MI, and all-cause mortality in older adults with higher cardiovascular risk remained to be defined.
Does complete revascularization reduce major adverse cardiovascular events, all-cause mortality, and myocardial infarction compared to incomplete revascularization in patients ≥ 70 years old with myocardial infarction?
Meta-Analysis (n=49,556)
Does complete revascularization reduce major adverse cardiovascular events, all-cause mortality, and myocardial infarction compared to incomplete revascularization in patients ≥ 70 years old with myocardial infarction?
Hazard Ratio: 0.82 (95% CI 0.7–0.97)
p-value: p=0.02
In elderly patients (≥ 70 years) with myocardial infarction, complete revascularization does not appear to offer a significant benefit in reducing mortality or myocardial infarction compared to incomplete revascularization.
No superiority of complete over incomplete revascularization for MACE, mortality, or MI in elderly patients; leaves open need for dedicated RCTs before practice change.
Coronary artery disease (CAD) is the leading cause of mortality in the United States, and percutaneous coronary intervention (PCI) is established as the standard after an acute episode of CAD. This review assessed the use of complete revascularization (CR) or incomplete revascularization (IR) in older adults, who present a higher cardiovascular risk. The aim is to define the effectiveness of both procedures in this population, focusing on major adverse cardiovascular events (MACE), myocardial infarction (MI), and all-cause mortality (ACM). A literature search identified 15 studies, evaluated using the Risk of Bias 2 (RoB 2) tool and the Risk of Bias in Non-Randomized Studies of Interventions I (ROBINS-I) tool for bias risk. Despite positive results in recent studies, this meta-analysis does not show the superiority of CR, demonstrating a lack of benefit in reducing mortality, myocardial infarction, and adverse events in the ≥ 70-year-old age group.
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Intriago et al. (2024) conducted a meta-analysis in Myocardial Infarction (n=49,556). Complete revascularization vs. Incomplete revascularization was evaluated on Major adverse cardiovascular events (MACE) (HR 0.82, 95% CI 0.70-0.97, p=0.02). Complete revascularization reduced the risk of major adverse cardiovascular events compared to incomplete revascularization in patients over 70 years old with myocardial infarction (HR 0.82).
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