Effect of complete revascularization in acute coronary syndrome after 75 years old: insights from the BleeMACS registry.

IF 1.8 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Geriatric Cardiology Pub Date : 2023-10-28 DOI:10.26599/1671-5411.2023.10.003

Ge Wang, Xiu-Huan Chen, Si-Yi Li, Ze-Kun Zhang, Wei Gong, Yan Yan, Shao-Ping Nie, José P Henriques

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引用次数: 0

Abstract

Background: The prognostic benefit of complete revascularization in elderly patients (aged over 75 years) with multi-vessel disease and acute coronary syndrome (ACS) is currently unclear. This study aimed to determine the long-term prognostic impact of complete revascularization in this population.

Methods: We conducted this study using data obtained from the BleeMACS (Bleeding complications in a Multicenter registry of patients discharged after an Acute Coronary Syndrome) registry, which was carried out from 2003 to 2014. The objective was to categorize older patients diagnosed with ACS into two groups: those who underwent complete revascularization and those who did not. Propensity score matching and the Kaplan-Meier analysis were employed to examine differences in one-year clinical outcomes. The primary endpoint was major adverse cardiovascular event (MACE), which encompassed a combination of all-cause mortality and myocardial infarction.

Results: Out of 1263 patients evaluated, 445 patients (35.2%) received complete revascularization. Patients who underwent complete revascularization had a higher prevalence of hypertension and prior percutaneous coronary intervention compared to those who did not. During the one-year follow-up period, complete revascularization was associated with a significantly decreased risk of MACE [13.7% vs. 20.5%, hazard ratio (HR) = 0.63, 95% CI: 0.45-0.88, P = 0.007] and a lower risk of myocardial infarction (5.9% vs. 9.9%, HR = 0.55, 95% CI: 0.33-0.92, P = 0.02). However, it was not linked to a lower risk of all-cause death (9.5% vs. 13.5%, HR = 0.68, 95% CI: 0.45-1.02, P = 0.06). Similar results were observed in the subgroup analysis.

Conclusions: Long-term clinical improvements were observed in ACS patients aged over 75 years with multi-vessel disease who achieved complete revascularization. Therefore, adhering to guidelines for complete revascularization should be recommended for elderly patients.

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75岁后急性冠状动脉综合征完全血运重建术的效果:来自BleeMACS注册的见解。

背景:对于患有多血管疾病和急性冠脉综合征(ACS)的老年患者(75岁以上)，完全血运重建术的预后益处目前尚不清楚。本研究旨在确定完全血运重建对该人群的长期预后影响。方法:我们使用2003年至2014年进行的BleeMACS(急性冠状动脉综合征出院患者出血并发症多中心登记处)登记处的数据进行了本研究。目的是将诊断为ACS的老年患者分为两组:接受完全血运重建术的患者和未接受完全血运重建术的患者。采用倾向评分匹配和Kaplan-Meier分析来检查一年临床结果的差异。主要终点是主要心血管不良事件(MACE)，包括全因死亡率和心肌梗死的组合。结果:1263例患者中，445例(35.2%)接受了完全血运重建术。与未接受完全血管重建术的患者相比，接受完全血管重建术的患者有更高的高血压患病率和既往经皮冠状动脉介入治疗。在一年的随访期间，完全血运重建与MACE风险显著降低(13.7% vs. 20.5%，风险比(HR) = 0.63, 95% CI: 0.45-0.88, P = 0.007)和心肌梗死风险降低(5.9% vs. 9.9%， HR = 0.55, 95% CI: 0.33-0.92, P = 0.02)相关。然而，它与全因死亡风险降低无关(9.5%对13.5%，HR = 0.68, 95% CI: 0.45-1.02, P = 0.06)。在亚组分析中也观察到类似的结果。结论:75岁以上伴有多血管疾病的ACS患者实现了完全的血运重建术，长期临床改善。因此，应建议老年患者坚持完全血运重建的指导方针。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Geriatric Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-GERIATRICS & GERONTOLOGY

CiteScore

3.30

自引率

4.00%

发文量

1161

期刊介绍： JGC focuses on both basic research and clinical practice to the diagnosis and treatment of cardiovascular disease in the aged people, especially those with concomitant disease of other major organ-systems, such as the lungs, the kidneys, liver, central nervous system, gastrointestinal tract or endocrinology, etc.