Comparison of long-term outcomes of complete vs. incomplete revascularization in elderly patients (≥75 years) with acute coronary syndrome and multi-vessel disease undergoing percutaneous coronary intervention
BackgroundThe optimal revascularization strategy for elderly patients with acute coronary syndrome (ACS) remains uncertain. We evaluated the impact of complete revascularization (CR) vs. incomplete revascularization (IR) in elderly ACS patients with multivessel disease (MVD) undergoing percutaneous...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2023-07-01
|
| Series: | Frontiers in Cardiovascular Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1037392/full |
| _version_ | 1797772824283185152 |
|---|---|
| author | Yu-Ying Lu Yu-Ying Lu Chen-Hung Lee Chen-Hung Lee Chun-Chi Chen Chun-Chi Chen Dong-Yi Chen Dong-Yi Chen Ming-Yun Ho Ming-Yun Ho Jih-Kai Yeh Jih-Kai Yeh Yu-Chang Huang Yu-Chang Huang Chieh-Yu Chang Chieh-Yu Chang Chao-Yung Wang Chao-Yung Wang Shang-Hung Chang Shang-Hung Chang Shang-Hung Chang I-Chang Hsieh I-Chang Hsieh Ming-Jer Hsieh Ming-Jer Hsieh |
| author_facet | Yu-Ying Lu Yu-Ying Lu Chen-Hung Lee Chen-Hung Lee Chun-Chi Chen Chun-Chi Chen Dong-Yi Chen Dong-Yi Chen Ming-Yun Ho Ming-Yun Ho Jih-Kai Yeh Jih-Kai Yeh Yu-Chang Huang Yu-Chang Huang Chieh-Yu Chang Chieh-Yu Chang Chao-Yung Wang Chao-Yung Wang Shang-Hung Chang Shang-Hung Chang Shang-Hung Chang I-Chang Hsieh I-Chang Hsieh Ming-Jer Hsieh Ming-Jer Hsieh |
| author_sort | Yu-Ying Lu |
| collection | DOAJ |
| description | BackgroundThe optimal revascularization strategy for elderly patients with acute coronary syndrome (ACS) remains uncertain. We evaluated the impact of complete revascularization (CR) vs. incomplete revascularization (IR) in elderly ACS patients with multivessel disease (MVD) undergoing percutaneous coronary intervention (PCI).MethodsUsing registry data from 2011 to 2019, we conducted a propensity-score matched cohort study. Elderly patients (≥75 years) with ACS and MVD who underwent PCI were divided into CR and IR groups based on angiography during index hospitalization. Major adverse cardiovascular events (MACEs), including all-cause mortality, recurrent non-fatal myocardial infarction, and any revascularization, were assessed at 3-year follow-up.ResultsAmong 1,018 enrolled patients, 496 (48.7%) underwent CR and 522 (51.3%) received IR. After 1:1 propensity-score matching, we analyzed 395 pairs. At 3-year follow-up, CR was significantly associated with lower MACE risk compared to IR (16.7% vs. 25.6%, HR = 0.65, 95% CI: 0.47–0.88, p = 0.006), driven by reduced all-cause mortality. This benefit was consistent across all pre-specified subgroups, particularly in ST segment elevation (STE)-ACS patients. In non-STE (NSTE)-ACS subgroup analysis, CR was also associated with a lower risk of cardiac mortality compared to IR (HR = 0.30, 95% CI: 0.12–0.75, p = 0.01).ConclusionIn elderly ACS patients with MVD undergoing PCI, CR demonstrates superior long-term outcomes compared to IR, irrespective of STE- or NSTE-ACS presentation. |
| first_indexed | 2024-03-12T21:56:33Z |
| format | Article |
| id | doaj.art-da59cded5f914872aee5cbaeb6811b1d |
| institution | Directory Open Access Journal |
| issn | 2297-055X |
| language | English |
| last_indexed | 2024-03-12T21:56:33Z |
| publishDate | 2023-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-da59cded5f914872aee5cbaeb6811b1d2023-07-25T17:05:37ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-07-011010.3389/fcvm.2023.10373921037392Comparison of long-term outcomes of complete vs. incomplete revascularization in elderly patients (≥75 years) with acute coronary syndrome and multi-vessel disease undergoing percutaneous coronary interventionYu-Ying Lu0Yu-Ying Lu1Chen-Hung Lee2Chen-Hung Lee3Chun-Chi Chen4Chun-Chi Chen5Dong-Yi Chen6Dong-Yi Chen7Ming-Yun Ho8Ming-Yun Ho9Jih-Kai Yeh10Jih-Kai Yeh11Yu-Chang Huang12Yu-Chang Huang13Chieh-Yu Chang14Chieh-Yu Chang15Chao-Yung Wang16Chao-Yung Wang17Shang-Hung Chang18Shang-Hung Chang19Shang-Hung Chang20I-Chang Hsieh21I-Chang Hsieh22Ming-Jer Hsieh23Ming-Jer Hsieh24Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanCenter for Big Data Analytics and Statistics, Department of Medical Research and Development, Chang Gung Memorial Hospital, Linkou, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanDivision of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, TaiwanCollege of Medicine, Chang Gung University, Taoyuan, TaiwanBackgroundThe optimal revascularization strategy for elderly patients with acute coronary syndrome (ACS) remains uncertain. We evaluated the impact of complete revascularization (CR) vs. incomplete revascularization (IR) in elderly ACS patients with multivessel disease (MVD) undergoing percutaneous coronary intervention (PCI).MethodsUsing registry data from 2011 to 2019, we conducted a propensity-score matched cohort study. Elderly patients (≥75 years) with ACS and MVD who underwent PCI were divided into CR and IR groups based on angiography during index hospitalization. Major adverse cardiovascular events (MACEs), including all-cause mortality, recurrent non-fatal myocardial infarction, and any revascularization, were assessed at 3-year follow-up.ResultsAmong 1,018 enrolled patients, 496 (48.7%) underwent CR and 522 (51.3%) received IR. After 1:1 propensity-score matching, we analyzed 395 pairs. At 3-year follow-up, CR was significantly associated with lower MACE risk compared to IR (16.7% vs. 25.6%, HR = 0.65, 95% CI: 0.47–0.88, p = 0.006), driven by reduced all-cause mortality. This benefit was consistent across all pre-specified subgroups, particularly in ST segment elevation (STE)-ACS patients. In non-STE (NSTE)-ACS subgroup analysis, CR was also associated with a lower risk of cardiac mortality compared to IR (HR = 0.30, 95% CI: 0.12–0.75, p = 0.01).ConclusionIn elderly ACS patients with MVD undergoing PCI, CR demonstrates superior long-term outcomes compared to IR, irrespective of STE- or NSTE-ACS presentation.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1037392/fullelderlycomplete revascularization (CR)acute coronary syndrome (ACS)multi-vessel diseasepercutaneous coronary intervention |
| spellingShingle | Yu-Ying Lu Yu-Ying Lu Chen-Hung Lee Chen-Hung Lee Chun-Chi Chen Chun-Chi Chen Dong-Yi Chen Dong-Yi Chen Ming-Yun Ho Ming-Yun Ho Jih-Kai Yeh Jih-Kai Yeh Yu-Chang Huang Yu-Chang Huang Chieh-Yu Chang Chieh-Yu Chang Chao-Yung Wang Chao-Yung Wang Shang-Hung Chang Shang-Hung Chang Shang-Hung Chang I-Chang Hsieh I-Chang Hsieh Ming-Jer Hsieh Ming-Jer Hsieh Comparison of long-term outcomes of complete vs. incomplete revascularization in elderly patients (≥75 years) with acute coronary syndrome and multi-vessel disease undergoing percutaneous coronary intervention Frontiers in Cardiovascular Medicine elderly complete revascularization (CR) acute coronary syndrome (ACS) multi-vessel disease percutaneous coronary intervention |
| title | Comparison of long-term outcomes of complete vs. incomplete revascularization in elderly patients (≥75 years) with acute coronary syndrome and multi-vessel disease undergoing percutaneous coronary intervention |
| title_full | Comparison of long-term outcomes of complete vs. incomplete revascularization in elderly patients (≥75 years) with acute coronary syndrome and multi-vessel disease undergoing percutaneous coronary intervention |
| title_fullStr | Comparison of long-term outcomes of complete vs. incomplete revascularization in elderly patients (≥75 years) with acute coronary syndrome and multi-vessel disease undergoing percutaneous coronary intervention |
| title_full_unstemmed | Comparison of long-term outcomes of complete vs. incomplete revascularization in elderly patients (≥75 years) with acute coronary syndrome and multi-vessel disease undergoing percutaneous coronary intervention |
| title_short | Comparison of long-term outcomes of complete vs. incomplete revascularization in elderly patients (≥75 years) with acute coronary syndrome and multi-vessel disease undergoing percutaneous coronary intervention |
| title_sort | comparison of long term outcomes of complete vs incomplete revascularization in elderly patients ≥75 years with acute coronary syndrome and multi vessel disease undergoing percutaneous coronary intervention |
| topic | elderly complete revascularization (CR) acute coronary syndrome (ACS) multi-vessel disease percutaneous coronary intervention |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1037392/full |
| work_keys_str_mv | AT yuyinglu comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT yuyinglu comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT chenhunglee comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT chenhunglee comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT chunchichen comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT chunchichen comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT dongyichen comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT dongyichen comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT mingyunho comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT mingyunho comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT jihkaiyeh comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT jihkaiyeh comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT yuchanghuang comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT yuchanghuang comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT chiehyuchang comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT chiehyuchang comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT chaoyungwang comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT chaoyungwang comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT shanghungchang comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT shanghungchang comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT shanghungchang comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT ichanghsieh comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT ichanghsieh comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT mingjerhsieh comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention AT mingjerhsieh comparisonoflongtermoutcomesofcompletevsincompleterevascularizationinelderlypatients75yearswithacutecoronarysyndromeandmultivesseldiseaseundergoingpercutaneouscoronaryintervention |