Complete revascularization in elderly patients with multi-vessel disease following acute coronary syndrome: A multicenter retrospective study.

Abstract

Background: In the elderly, acute coronary syndromes (ACS) are particularly challenging, especially with multivessel disease (MVD). Concerns about outcomes and limited evidence often lead to conservative treatment. While complete revascularization benefits in younger patients are well established, uncertainties persist for older individuals.

Methods: A national multicenter, retrospective cohort study of 629 patients older than 75 with ACS and MVD was divided into two groups: complete revascularization (CR) and culprit-only (CO) revascularization. The in-hospital composite outcome of death and major adverse cardiovascular events (MACE) and the follow-up composite outcome of death and cardiovascular hospital admission were assessed.

Results: Of 629 patients, 383 (66 %) were successfully revascularized: 254 (66 %) with CO revascularization and 129 (34 %) with CR. The mean age between groups was similar; in the CO group, it was 82 ± 5 years, while in the CR group, it was 81 ± 5 years (p = 0.4). The proportion of females was similar (42 % vs. 39 %). There was a higher ST-segment elevation myocardial infarction rate in the CO group (62 % vs 38 %, p < 0.01). CR was associated with a lower rate of in-hospital events (35 % vs 51 %, p = 0.025; OR 0.62 95 %CI [0.4-0.9]). Not only was there an association between CR and a lower number of in-hospital deaths (6 % vs. 19 %, p < 0.01; OR 0.3 95 %CI [0.15-0.67]) but also with lower in-hospital MACE (34 % vs. 49 % p = 0.02; OR 0.6 95 %CI [0.4-0.9]). During follow-up, complete revascularization was non-significantly associated with lower mortality (14 % vs. 15 %, p = 0.4), hospital admissions (22 % vs. 25 %, p = 0.2), and the composite outcome (35 % vs. 40 %, p = 0.2) compared with the culprit-only cohort. The survival curves of both groups were statistically similar (p = 0.16).

Conclusion: In older patients with ACS and MVD, the ideal revascularization strategy is still to be determined. However, CR was associated with lower in-hospital deaths and MACE without significant difference in follow-up events, deaths, and hospital admissions. The choice of revascularization strategy should be carefully individualized and tailored considering patient-specific factors, clinical presentation, and overall risk profile.