Systematic review and meta-analysis comparing complete versus incomplete or culprit-only revascularization by
Aman Goyal1, Muhammad Daoud Tariq2, Ajeet Singh3
1Department of Internal Medicine, Seth GS Medical College and KEM Hospital, Mumbai, India.
Insights
Complete revascularization (CR) in elderly patients with acute coronary syndrome and multi-vessel disease significantly reduces mortality and myocardial infarction risk compared to incomplete revascularization (IR). This strategy offers improved outcomes for this vulnerable population.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Medicine
Background:
- Complete revascularization (CR) is generally preferred over incomplete revascularization (IR) for acute coronary syndrome (ACS) with multi-vessel disease (MVD) due to superior long-term outcomes.
- Optimal revascularization strategy in elderly patients remains unclear due to factors like frailty, polypharmacy, and comorbidities.
Purpose of the Study:
- To evaluate the comparative effectiveness of complete revascularization (CR) versus incomplete revascularization (IR) in elderly patients undergoing percutaneous coronary intervention (PCI).
- To assess the impact of CR versus IR on mortality, myocardial infarction, and other adverse events in this specific patient group.
Main Methods:
- A systematic literature search was conducted across Medline, PubMed, and Google Scholar up to April 2024.
- A meta-analysis of 14 studies involving 62,577 elderly patients undergoing PCI was performed using random-effects models.
Main Results:
- CR significantly reduced all-cause mortality (RR: 0.680), cardiovascular mortality (RR: 0.620), and myocardial infarction (RR: 0.675) compared to IR.
- No significant differences were observed in the risk of stroke, major bleeding, stent thrombosis, or contrast-induced acute kidney injury between CR and IR groups.
Conclusions:
- Complete revascularization (CR) appears to be a favorable strategy for elderly patients undergoing PCI for ACS and MVD.
- CR is associated with a significant reduction in mortality and repeat myocardial infarction, supporting its use in this population.
Background:
Complete revascularization (CR) is favored over culprit-only or incomplete revascularization (IR) for patients with acute coronary syndrome (ACS) and multi-vessel disease (MVD) due to better long-term outcomes. However, the optimal revascularization strategy is currently uncertain in elderly patients, where frailty, polypharmacy, multi-morbidity, inherent bleeding risk and presumed cognitive decline can often burden the decision-making process.
Methods:
We searched Medline, PubMed, and Google Scholar from inception to April 2024. The search of databases identified relevant studies that reported the comparative effects of CR and IR in the elderly population undergoing percutaneous coronary intervention (PCI). Data was pooled for individual studies using random-effects models on Comprehensive Meta-Analysis software, with statistical significance set at p < 0.05.
Results:
The meta-analysis included 14 studies and 62577 patients. CR demonstrated a significant reduction in all-cause mortality [RR: 0.680; 95 % CI: 0.57-0.82; p=<0.001], cardiovascular-related mortality [RR: 0.620; 95 % CI: 0.478-0.805; p=<0.001], and myocardial infarction [RR: 0.675; 95 % CI: 0.553-0.823; p=<0.001] rates. There was no difference between the risk of stroke [RR: 1.044; 95 % CI: 0.733-1.486; p = 0.81], major bleeding [RR: 1.001; 95 % CI: 0.787-1.274; p = 0.991], stent thrombosis [RR: 1.015; 95 % CI: 0.538-1.916; p = 0.936], and contrast-induced acute kidney injury [RR: 1.187; 95 % CI: 0.963-1.464; p = 0.109].
Conclusion:
The meta-analysis suggests that CR may be a favorable revascularization strategy for elderly patients undergoing PCI, displaying a significant decrease in mortality and repeat myocardial infarction risk.
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