Association of complete revascularization with safety and outcomes in elderly patients with multi-vessel coronary artery disease: a systematic review and meta-analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-12-01 Epub Date: 2025-10-21 DOI:10.1016/j.ijcha.2025.101825

David T. Zhang , Matt Raven , Manasa Dondapati , Ravi Masson , Puja B. Parikh , Travis Bench , John P. Reilly , Michael Tao

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引用次数: 0

Abstract

Background

The utility of complete revascularization has been well defined in young patients with acute coronary syndrome (ACS) and multivessel coronary artery disease (CAD). However, the clinical benefit in elderly patients remains unclear with current literature has yielded conflicting results. This meta-analysis aims to evaluate the association of complete versus culprit-only coronary revascularization with mortality in elderly patients with multivessel CAD.

Methods

A literature search was conducted for studies reporting on outcomes after complete versus culprit-only revascularization in elderly patients with multivessel CAD presenting with ACS. The primary endpoint was all-cause mortality. The main secondary endpoint was cardiovascular (CV) mortality. The search included the following databases: PubMed, EMBASE, and Web of Science. The search was not restricted to time or publication status.

Results

14 studies with 11,994 elderly patients (7,236 with culprit-only, 4,758 with complete revascularization) met inclusion criteria. Mean follow-up duration was 29.0 months (range 12–56 months), mean age was 79.5 years old, 56.9% of patients were men, and mean left ventricular ejection fraction was 54.3%. Patients who underwent complete revascularization had significantly lower all-cause and CV mortality compared to culprit-only revascularization (OR 1.75, 95% CI 1.40–2.18; p < 0.001; OR 1.75, 95% CI 1.14–2.68; p = 0.01). Subgroup analysis demonstrated this association to be statistically significant for studies with cohorts presenting with non-ST segment elevation myocardial infarction (NSTEMI) and mixed cohorts that included NSTEMI and ST segment elevation myocardial infarction (STEMI) patients. However, there was no significant difference in risk of all-cause mortality with complete versus culprit-only revascularization in studies of only STEMI patients (OR 1.03, 95% CI 0.61–1.72; p = 0.92).

Conclusion

Complete coronary revascularization is associated with lower risk of all-cause and CV mortality in elderly patients with multivessel CAD presenting with NSTEMI. However, there does not appear to be a difference in outcomes in patients presenting with STEMI.

查看原文本刊更多论文

老年多支冠状动脉疾病患者完全血运重建术与安全性和预后的关系：一项系统综述和荟萃分析

背景：完全血运重建术在年轻急性冠状动脉综合征（ACS）和多支冠状动脉疾病（CAD）患者中的应用已经得到了明确的定义。然而，老年患者的临床获益尚不清楚，目前的文献得出了相互矛盾的结果。本荟萃分析旨在评估老年多血管冠心病患者完全冠脉重建术与单纯冠脉重建术与死亡率的关系。方法对伴有ACS的老年多血管CAD患者行完全血管重建术与仅行罪魁祸首血管重建术的结果进行文献检索。主要终点是全因死亡率。主要的次要终点是心血管（CV）死亡率。搜索包括以下数据库：PubMed， EMBASE和Web of Science。搜索不限于时间或出版状态。结果14项研究纳入11,994例老年患者（仅罪魁祸首7236例，完全血运重建4758例）。平均随访时间29.0个月（12-56个月），平均年龄79.5岁，男性56.9%，平均左室射血分数54.3%。完全血运重建术患者的全因死亡率和CV死亡率明显低于单纯的罪魁祸首血运重建术患者（OR 1.75, 95% CI 1.40-2.18; p < 0.001; OR 1.75, 95% CI 1.14-2.68; p = 0.01）。亚组分析表明，在以非ST段抬高型心肌梗死（NSTEMI）为研究对象的队列和包括NSTEMI和ST段抬高型心肌梗死（STEMI）患者的混合队列中，这种关联具有统计学意义。然而，在仅STEMI患者的研究中，完全血运重建与仅罪魁祸首血运重建的全因死亡率风险无显著差异（OR 1.03, 95% CI 0.61-1.72; p = 0.92）。结论完全冠状动脉血运重建术与老年多血管冠心病合并NSTEMI患者全因死亡率和CV死亡率降低相关。然而，STEMI患者的预后似乎没有差异。

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

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.