Mikiko Harada1, Takashi Miura2, Takahiro Kobayashi3, Hideki Kobayashi2, Masanori Kobayashi4, Hiroyuki Nakajima5, Hikaru Kimura6, Hiroshi Akanuma7, Eiichiro Mawatari8, Toshio Sato9, Shoji Hotta10, Yuichi Kamiyoshi11, Takuya Maruyama12, Noboru Watanabe13, Takayuki Eisawa14, Naoto Hashizume12, Soichiro Ebisawa2, Yusuke Miyashita15, Uichi Ikeda16. 1. Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Nagano Prefectural Suzaka Hospital, Nagano, Japan. Electronic address: m02039mk@jichi.ac.jp. 2. Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan. 3. Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan. 4. Department of Arrhythmology, Takatsuki General Hospital, Osaka, Japan. 5. Department of Cardiology, Nagano Matsushiro General Hospital, Nagano, Japan. 6. Department of Cardiology, Saku Medical Center, Nagano, Japan. 7. Department of Cardiology, Iida Municipal Hospital, Nagano, Japan. 8. Department of Cardiology, North Alps Medical Center Azumi Hospital, Nagano, Japan. 9. Department of Cardiology, Okaya City Hospital, Nagano, Japan. 10. Hotta Medical Clinic, Nagano, Japan. 11. Department of Cardiology, Aizawa Hospital, Nagano, Japan. 12. Department of Cardiology, Shinonoi General Hospital, Nagano, Japan. 13. Department of Cardiology, Hokushin General Hospital, Nagano, Japan. 14. Department of Cardiology, Komoro Kosei General Hospital, Japan. 15. Department of Cardiovascular Medicine, Nagano Red Cross Hospital, Nagano, Japan. 16. Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan.
Abstract
BACKGROUND: Prior reports have revealed that complete revascularization (CR) by percutaneous coronary intervention (PCI) decreased ischemic events. However, little is known about the efficacy of CR using PCI in elderly patients with multi-vessel coronary artery disease (CAD). We evaluated the 1-year effectiveness of CR-PCI in elderly patients (≥75years old) with multi-vessel CAD. METHODS: The SHINANO Registry, a prospective, observational, multi-center, all-comer cohort study, has enrolled 1923 patients. From this registry, we recruited 322 elderly patients with multi-vessel CAD. The primary endpoint was major adverse cardiovascular events ([MACE]: all-cause mortality, myocardial infarction, and stroke). RESULTS: Of the 322 elderly patients with multi-vessel CAD, 165 (51.2%) received CR and 157 (48.8%) received incomplete revascularization (ICR). MACE occurred in 44 (13.7%) patients. The incidence of MACE by survival analysis was significantly lower in the CR group than in the ICR group (7.4% vs. 21.1%, p<0.001). On multivariable Cox proportional hazards analysis of age, sex, and acute coronary syndrome (ACS), ACS and CR were independent predictors of MACE (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.29-4.80; p=0.007, HR, 0.40; 95% CI, 0.20-0.77; p=0.007, respectively). In propensity score matching of age, sex, previous heart failure, previous intracranial bleeding, ACS, and body mass index, the MACE rate was significantly lower in the CR group than in the ICR group (7.2% vs. 18.4%, p=0.015). CONCLUSIONS: Even in elderly patients over 75years old with multi-vessel CAD, CR-PCI appears to suppress mid-term ischemic events.
BACKGROUND: Prior reports have revealed that complete revascularization (CR) by percutaneous coronary intervention (PCI) decreased ischemic events. However, little is known about the efficacy of CR using PCI in elderly patients with multi-vessel coronary artery disease (CAD). We evaluated the 1-year effectiveness of CR-PCI in elderly patients (≥75years old) with multi-vessel CAD. METHODS: The SHINANO Registry, a prospective, observational, multi-center, all-comer cohort study, has enrolled 1923 patients. From this registry, we recruited 322 elderly patients with multi-vessel CAD. The primary endpoint was major adverse cardiovascular events ([MACE]: all-cause mortality, myocardial infarction, and stroke). RESULTS: Of the 322 elderly patients with multi-vessel CAD, 165 (51.2%) received CR and 157 (48.8%) received incomplete revascularization (ICR). MACE occurred in 44 (13.7%) patients. The incidence of MACE by survival analysis was significantly lower in the CR group than in the ICR group (7.4% vs. 21.1%, p<0.001). On multivariable Cox proportional hazards analysis of age, sex, and acute coronary syndrome (ACS), ACS and CR were independent predictors of MACE (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.29-4.80; p=0.007, HR, 0.40; 95% CI, 0.20-0.77; p=0.007, respectively). In propensity score matching of age, sex, previous heart failure, previous intracranial bleeding, ACS, and body mass index, the MACE rate was significantly lower in the CR group than in the ICR group (7.2% vs. 18.4%, p=0.015). CONCLUSIONS: Even in elderly patients over 75years old with multi-vessel CAD, CR-PCI appears to suppress mid-term ischemic events.
Authors: Ada Del Mar Carmona-Segovia; María Victoria Doncel-Abad; Víctor M Becerra-Muñoz; Jorge Rodríguez-Capitán; Fernando Sabatel-Pérez; María Flores-López; María José Sánchez-Quintero; Dina Medina-Vera; Ana Isabel Molina-Ramos; Rajaa El Bekay; José Miguel Morales-Asencio; María Angullo-Gómez; Luis García-Rodríguez; Lucía Palma-Martí; Francisco Javier Pavón-Morón; Manuel F Jiménez-Navarro Journal: BMJ Open Date: 2022-02-28 Impact factor: 2.692