OR06-1
Association of Complete Revascularization with Mortality in Elderly Patients with Multi-Vessel Coronary Artery Disease: A Systematic Review and Meta-Analysis
Presenter
Matthew Raven, MD, Stonybrook Hospital, Patchogue, NY
Matthew Raven, MD1, Michael Tao, MD2, Manasa Dondapati, MD3, Ishmam Ibtida3, Alejandro Maldonado, MD3, Paola Pastena, MD3, Ravi Masson, MD3, Puja B. Parikh, M.D., FSCAI3, Travis Bench, M.D.4 and JP P. Reilly, M.D., FSCAI5, (1)Stonybrook Hospital, Patchogue, NY, (2)Stony Brook University Hospital, Port Jefferson, NY, (3)Stony Brook University Hospital, Stony Brook, NY, (4)Stonybrook Southampton, Sayville, NY, (5)Stony Brook University Hospital, Southampton, NY
Keywords: Acute Coronary Syndromes (ACS) and Coronary
Background:
The clinical benefit in elderly patients remains unclear with current literature yielding conflicting results. This meta-analysis aims to evaluate the association of complete versus culprit only revascularization with mortality in elderly patients with multivessel coronary artery disease (CAD).
Methods:
A literature search was conducted for studies reporting on outcomes after complete versus culprit only PCI in elderly patients with multivessel CAD presenting with ACS. The primary end-point was all-cause mortality. The secondary endpoint was cardiovascular (CV) mortality. Databases searched included Pubmed, EMBASE, and Web of Science.
Results:
13 studies with 10,549 patients met inclusion criteria. Mean follow-up was 29 months (ranging 12 to 56 months), mean age was 80 years old, mean ejection fraction was 55%.
Patients who underwent complete revascularization had significantly lower all-cause and CV mortality compared to culprit-only revascularization (OR 1.79, 95% CI 1.4-2.28; p<0.01; OR 1.80, 95% CI 1.08-3.01; p=0.02). Subgroup analysis demonstrated the association between complete revascularization and all-cause mortality was not significant in studies of only patients with ST-segment elevation myocardial infarction (STEMI) (OR 1.03, 95% CI 0.61-1.72; p=0.92).
Conclusions:
Complete coronary revascularization is associated with lower risk of all-cause and CV mortality in elderly patients with multivessel CAD presenting with ACS. However, there may be differences in this association between patients presenting with with non-ST segment elevation myocardial infarction compared to patients presenting with STEMI. 