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Complete Versus Incomplete Revascularization in Elderly Patients With Myocardial Infarction: A Systematic Review and

Cesar Intriago1, Cristopher-Josué Escudero2, Jesús Endara-Mina2

  • 1Research, Larkin Community Hospital, South Miami, USA.

Cureus
|December 23, 2024
PubMed

Insights

Complete revascularization (CR) does not appear to offer benefits over incomplete revascularization (IR) for older adults undergoing percutaneous coronary intervention (PCI). This meta-analysis found no significant reduction in mortality or adverse events in patients aged 70 and above.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Medicine

Background:

  • Coronary artery disease (CAD) is a leading cause of death in the US.
  • Percutaneous coronary intervention (PCI) is a standard treatment for acute CAD.
  • Older adults have higher cardiovascular risks and unique treatment considerations.

Purpose of the Study:

  • To evaluate the effectiveness of complete revascularization (CR) versus incomplete revascularization (IR) in patients aged 70 and older.
  • To compare major adverse cardiovascular events (MACE), myocardial infarction (MI), and all-cause mortality (ACM) between CR and IR.
  • To assess the impact of revascularization strategies on cardiovascular outcomes in the elderly population.

Main Methods:

  • A literature search identified 15 relevant studies.
  • Risk of bias was assessed using the Risk of Bias 2 (RoB 2) and ROBINS-I tools.
  • A meta-analysis was conducted to synthesize the findings.

Main Results:

  • The meta-analysis did not demonstrate the superiority of complete revascularization (CR).
  • CR did not show a significant benefit in reducing all-cause mortality (ACM) or myocardial infarction (MI).
  • No significant reduction in major adverse cardiovascular events (MACE) was observed with CR compared to IR in older adults.

Conclusions:

  • Complete revascularization (CR) does not appear to provide additional benefits over incomplete revascularization (IR) for patients aged 70 and older undergoing PCI.
  • Current evidence does not support CR as a superior strategy for improving mortality or reducing adverse events in this specific demographic.
  • Further research may be needed to clarify optimal revascularization strategies for elderly patients with CAD.

Keywords:
coronary artery diseasecoronary revascularizationmajor adverse cardiovascular eventsmyocardial infarctionolder adults

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