Clinical impact of complete revascularization in elderly patients with multi-vessel coronary artery disease undergoing percutaneous coronary intervention: A sub-analysis of the SHINANO registry. (1st March 2017)

• Record Type: Journal Article
• Authors: Harada, Mikiko; Miura, Takashi; Kobayashi, Takahiro; Kobayashi, Hideki; Kobayashi, Masanori; Nakajima, Hiroyuki; Kimura, Hikaru; Akanuma, Hiroshi; Mawatari, Eiichiro; Sato, Toshio; Hotta, Shoji; Kamiyoshi, Yuichi; Maruyama, Takuya; Watanabe, Noboru; Eisawa, Takayuki; Hashizume, Naoto; Ebisawa, Soichiro; Miyashita, Yusuke; Ikeda, Uichi
• Is Part Of: International journal of cardiology. Volume 230(2017)
• Page Start: 413
• Page End: 419
• Publication Date: 2017-03-01
• Subjects: CR complete revascularization -- ICR incomplete revascularization -- PCI percutaneous coronary intervention -- CAD coronary artery disease -- STEMI ST-segment elevated myocardial infarction -- NSTEMI non-ST-segment elevated myocardial infarction -- UA unstable angina -- MACE major adverse cardiovascular events -- MI myocardial infarction -- IHD ischemic heart disease -- HF heart failure -- QOL quality of life -- ACS acute coronary syndrome -- CABG coronary artery bypass surgery -- BP blood pressure -- BMI body mass index -- eGFR estimated glomerular filtration rate -- LVEF left ventricular ejection fracture -- PAD peripheral artery disease -- SYNTAX synergy between PCI with TAXUS™ and cardiac surgery -- CTO chronic total occlusion -- IABP intra-aortic balloon pumping -- HR hazard ratio -- CI confidence interval -- ADL activities of daily living -- DES drug eluting stent; Complete revascularization -- Multi-vessel coronary artery disease -- Percutaneous coronary intervention -- Major adverse cardiovascular events -- Elderly; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.12.093
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Background: Prior reports have revealed that complete revascularization (CR) by percutaneous coronary intervention (PCI) decreased ischemic events. However, little is known about the efficacy of CR using PCI in elderly patients with multi-vessel coronary artery disease (CAD). We evaluated the 1-year effectiveness of CR-PCI in elderly patients (≥ 75 years old) with multi-vessel CAD. Methods: The SHINANO Registry, a prospective, observational, multi-center, all-comer cohort study, has enrolled 1923 patients. From this registry, we recruited 322 elderly patients with multi-vessel CAD. The primary endpoint was major adverse cardiovascular events ([MACE]: all-cause mortality, myocardial infarction, and stroke). Results: Of the 322 elderly patients with multi-vessel CAD, 165 (51.2%) received CR and 157 (48.8%) received incomplete revascularization (ICR). MACE occurred in 44 (13.7%) patients. The incidence of MACE by survival analysis was significantly lower in the CR group than in the ICR group (7.4% vs. 21.1%, p < 0.001). On multivariable Cox proportional hazards analysis of age, sex, and acute coronary syndrome (ACS), ACS and CR were independent predictors of MACE (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.29–4.80; p = 0.007, HR, 0.40; 95% CI, 0.20–0.77; p = 0.007, respectively). In propensity score matching of age, sex, previous heart failure, previous intracranial bleeding, ACS, and body mass index, the MACE rate was significantly lower in the CR group than in the ICR group (7.2% vs. 18.4%, p = 0.015). Conclusions: Even in elderly patients over 75 years old with multi-vessel CAD, CR-PCI appears to suppress mid-term ischemic events.