Complete versus partial revascularization for older adults with acute coronary syndrome: a meta-analysis and
André Luiz Carvalho Ferreira1, Luanna Paula Garcez de Carvalho Feitoza2, Ana Yasmin Cáceres Lessa3
1Department of Medicine, Pontifical Catholic University of Parana, Curitiba.
Coronary Artery Disease
|June 3, 2024
Summary
Complete revascularization significantly lowers mortality and recurrent heart attacks in elderly patients with acute coronary syndrome and multivessel disease. This approach is safer than culprit-only procedures for this vulnerable population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Randomized trials suggest complete revascularization is superior to culprit-only revascularization for acute coronary syndrome (ACS) and multivessel coronary artery disease (MVD).
- The benefit of complete revascularization in elderly patients (≥75 years) with ACS and MVD remains under-explored.
Purpose of the Study:
- To systematically review and compare the clinical outcomes of complete versus partial-only percutaneous coronary intervention (PCI) in elderly patients with ACS and MVD.
- To evaluate the impact of complete revascularization on mortality and myocardial infarction in this specific demographic.
Main Methods:
- A systematic review and meta-analysis of studies comparing complete versus partial-only PCI in elderly patients (age ≥75 years) with ACS and MVD.
- Searches were conducted in PubMed, Embase, and Cochrane databases.
- Pooled hazard ratios (HR) with 95% confidence intervals (CI) were calculated for time-to-event data.
Main Results:
- Seven studies were included (2 RCTs, 5 cohort studies) with 10,147 patients; 43.8% received complete revascularization.
- Complete revascularization was associated with significantly lower all-cause mortality (HR 0.71, 95% CI 0.60-0.85) and cardiovascular mortality (HR 0.64, 95% CI 0.52-0.79).
- A reduced risk of recurrent myocardial infarction (HR 0.65, 95% CI 0.50-0.85) was observed with complete revascularization; no significant difference in revascularization rates was found (HR 0.80, 95% CI 0.53-1.20).
Conclusions:
- Complete revascularization in elderly patients with ACS and MVD is linked to reduced all-cause and cardiovascular mortality.
- The findings suggest complete revascularization is a beneficial strategy for improving survival in older patients with complex coronary artery disease.
- Complete revascularization may reduce the risk of recurrent myocardial infarction in this elderly population.
More Related Videos
06:30Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
5.9K
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
3.4K
Related Concept Videos
01:10Pre-Procedural Guidelines for Assessing Blood Pressure
Accurate blood pressure assessment is crucial for diagnosing and managing various health conditions. To ensure the reliability of these measurements, healthcare professionals must adhere to standardized pre-procedural guidelines. These guidelines enhance patient safety and improve the overall quality of healthcare. The following steps are essential for obtaining accurate and consistent blood pressure readings, from using the appropriate tools to ensuring effective communication with the patient.
01:23Assessment of the Cardiovascular System I: Subjective Data
A thorough health history and physical assessment are essential for identifying cardiovascular disease (CVD) symptoms and distinguishing them from other health issues.
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
Initial Enquiry
Ask the patient about their primary concern and thoroughly explore all reported symptoms.
Medical History
Investigate past illnesses affecting the cardiovascular system, such as angina, anemia, rheumatic fever, congenital heart disease, stroke, thrombophlebitis, dysrhythmias, varicosities
Inquire about symptoms...
01:27Assessment of the Cardiovascular System III: Palpation
Palpation involves feeling the body to evaluate texture, size, consistency, and tenderness for assessing cardiovascular health. The following steps are organized in a head-to-toe order:
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...
Jugular Venous Pressure (JVP) Measurement
Position the patient at a thirty- to forty-five-degree angle or in a semi-fowler's position. Look for the highest point of pulsation in the internal jugular vein and measure the vertical distance to the angle of Loius or sternal angle. A normal JVP is 3-4 cm above the...
01:27Coronary Artery Disease V: Interprofessional Care
Interprofessional care for coronary artery disease includes pharmacological therapy and revascularization procedures.Pharmacological therapy for Coronary Artery Disease (CAD) aims to manage symptoms, prevent complications, and improve patient outcomes through various classes of medications:Antiplatelet Agents:Aspirin and Clopidogrel: These medications inhibit platelet aggregation, preventing blood clots, which is crucial for avoiding heart attacks and strokes. Doctors often prescribe these...
01:21Peripheral Arterial Disease II: Clinical Manifestations and Diagnostic Evaluation
Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
01:27Peripheral Artery Disease III: Interprofessional Care
Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...