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Staged revascularization vs. culprit-only percutaneous coronary intervention for multivessel disease in elderly
Jiachun Lang1,2, Chen Wang1,2, Le Wang2
1Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
Insights
For elderly patients with ST-elevation myocardial infarction (STEMI) and multivessel disease (MVD), staged percutaneous coronary intervention (PCI) significantly reduces major adverse cardiac and cerebrovascular events (MACCE) compared to culprit-only PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Multivessel disease (MVD) in ST-elevation myocardial infarction (STEMI) requires careful revascularization strategies.
- The optimal approach for elderly STEMI patients with MVD remains debated.
- Staged versus culprit-only percutaneous coronary intervention (PCI) is a key consideration.
Purpose of the Study:
- To compare clinical outcomes of staged PCI versus culprit-only PCI.
- To evaluate the safety and efficacy in elderly STEMI patients with MVD.
- To identify the superior revascularization strategy for this specific cohort.
Main Methods:
- Retrospective analysis of 617 elderly patients (≥65 years) with STEMI and MVD.
- Patients underwent either staged or culprit-only PCI.
- Propensity score matching (PSM) was used to control for confounding factors.
- Primary endpoint: major adverse cardiac and cerebrovascular events (MACCE).
Main Results:
- Staged PCI was associated with a lower risk of MACCE, all-cause death, and cardiac death.
- This benefit was observed in both the overall and PSM cohorts.
- No significant differences were found for stroke or ischemia-driven revascularization.
Conclusions:
- Staged PCI demonstrates superiority over culprit-only PCI in elderly STEMI patients with MVD.
- Staged PCI is a significant predictor of reduced MACCE and all-cause mortality.
- This strategy offers improved clinical outcomes for this vulnerable population.
Backgroundand Objective:
Studies have highlighted the significant role of staged percutaneous coronary intervention (PCI) for a multivessel disease (MVD) among patients with ST-elevation myocardial infarction (STEMI). However, the relative benefit of staged vs. culprit-only PCI for MVD in elderly patients with STEMI remains undetermined. Thus, the present study compared the clinical outcomes of staged and culprit-only PCI in this cohort.
Methods:
From January 2014 to September 2019, 617 patients aged ≥65 years with STEMI and MVD who underwent primary PCI of the culprit vessels within 12 h of symptom onset were enrolled. They were then categorized into the staged and culprit-only PCI groups according to intervention strategy. Propensity score matching (PSM) was conducted to adjust for confounding factors between groups. The primary end point was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, cardiac death, recurrent myocardial infarction (MI), stroke, and ischemia-driven revascularization.
Results:
During a mean follow-up of 56 months, 209 patients experienced MACCE and 119 died. Staged revascularization was associated with a lower risk of MACCE, all-cause death, and cardiac death than culprit-only PCI in both overall patients and the PSM cohorts. In contrast, there was no significant difference in stroke or ischemia-driven revascularization. Moreover, on multivariate Cox regression analysis, staged PCI was a significant predictor of a lower incidence of MACCE and all-cause death.
Conclusion:
In elderly patients with STEMI and MVD, staged PCI is superior to culprit-only PCI.
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