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[Outcomes of Various Revascularisation Strategies in the Elderly STEMI Patients With Multi-Vessel Coronary Pathology]

R S Tarasov1,2, A M Kochergina1,2, V I Ganyukov1,2

  • 1Research Institute for Complex Problems of Cardiovascular Diseases, Kemerovo, Russia.

Kardiologiia
|August 2, 2017
PubMed

Insights

Single-stage complete revascularization using multivessel stenting (MS) is safe and effective for ST-elevation myocardial infarction (STEMI) patients of all ages. While 30-day mortality was higher in older patients, 1-year outcomes were similar between MS and staged revascularization groups.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Acute ST-elevation myocardial infarction (STEMI) management requires timely revascularization.
  • Percutaneous coronary intervention (PCI) is a primary treatment strategy for STEMI.
  • The optimal revascularization strategy, particularly multivessel stenting (MS) versus staged revascularization (SR), in elderly and middle-aged STEMI patients undergoing primary PCI (pPCI) remains an area of investigation.

Purpose of the Study:

  • To assess the safety and efficacy of single-stage complete revascularization via multivessel stenting (MS) as primary percutaneous coronary intervention (pPCI).
  • To compare outcomes between MS and staged revascularization (SR) strategies in elderly (≥65 years) and middle-aged (<64 years) STEMI patients.

Main Methods:

  • Retrospective analysis of 327 STEMI patients undergoing pPCI between 2009 and 2013.
  • Patients were categorized into elderly (≥65 years, n=103) and middle-aged (<64 years, n=224) groups.
  • Comparison of clinical outcomes, including mortality, myocardial infarction, and unplanned revascularization at 12-month follow-up, between MS and SR subgroups within each age category.

Main Results:

  • No significant differences in baseline characteristics between MS and SR subgroups within age groups.
  • Multivessel stenting (MS) was found to be safe and effective across both age groups.
  • While 30-day mortality was higher in the elderly group (≥65 years), 1-year outcomes (mortality, MI, TVR) showed no significant differences between MS and SR strategies within either the elderly or middle-aged cohorts.

Conclusions:

  • Single-stage complete revascularization with multivessel stenting (MS) is a safe and effective strategy for STEMI patients, regardless of age.
  • The choice between MS and staged revascularization (SR) does not significantly impact 1-year clinical outcomes in STEMI patients when performed as primary PCI.
  • Elderly STEMI patients may experience higher short-term mortality, but long-term results are comparable between revascularization strategies.
Abstract

Keywords:
multivessel stentingmyocardial infarctionoutcomes of revascularization in the elderlyprimary PCIstaged revascularization

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