Abstract
The benefit of complete revascularization in elderly patients with non-ST elevation myocardial infarction (NSTEMI), and multivessel disease remains debated (MVD). The aim of our study was to determine the current long-term prognostic benefit of complete revascularization in this population. A retrospective cohort study of 1722 consecutive elderly NSTEMI patients was performed. Among the study participants 30.4% (n = 524) were completed revascularizated and in 69.6% (n = 1198) culprit vessel only revascularization was performed. A propensity score analysis was performed and we divided the study population into two groups: complete revascularization (n = 500) and culprit vessel only revascularization (n = 500). The median follow-up was 45.7 months, the all cause mortality (44.5% vs 30.5%, p < 0.001) (HR 0.74 (0.57-0.97); p = 0.035) and cardiovascular mortality (32.6% vs 17.4%, p < 0.001) (HR = 0.67 (0.47-0.94); p = 0.021) were significantly lower in patients with complete revascularization. In our study, we observed a long-term benefit of complete revascularization in elderly NSTEMI and MVD patients. Elderly patients should also be managed according to current guidelines to improve their long-term prognosis.
Highlights
Nowadays, non-ST elevation myocardial infarction (NSTEMI) is the most frequent manifestation of acute coronary syndrome (ACS) [1]
Our study aims to analyze the long-term prognosis of complete revascularization (CCR) compared with culprit vessel only (CV) in a cohort of elderly patients with NSTEMI and multivessel disease (MVD) in a real life registry
CV revascularization was defined as revascularization of only the infarct-related artery, and complete revascularization was performed as a routine staged PCI (i.e., PCI during a procedure separate from the index PCI procedure for NSTEMI) of all suitable non-culprit lesions, regardless of whether there were clinical symptoms or there was evidence of ischemia
Summary
Non-ST elevation myocardial infarction (NSTEMI) is the most frequent manifestation of acute coronary syndrome (ACS) [1]. Recent studies have suggested that in NSTEMI patients with MVD, complete coronary revascularization (CCR) appears to be superior to culprit vessel only (CV) PCI in NSTEMI patients with MVD [6] Both the European Society of Cardiology and the American College of Cardiology guidelines do not specify the extent of revascularization giving a class IIa for complete revascularization in STEMI patients [3, 4, 7]. 30% of the patients included in the European NSTEMI-ACS registries [8, 9] are older than 75 years. Those patients are underrepresented in randomized clinical trials (i.e., 13% in the TRITON-TIMI 38 study and 15% in the PLATO study) [10, 11]. Due to a selection bias, elderly individuals enrolled in clinical trial may not be representative of the population treated in everyday clinical practice
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