Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.08.019
Andrew Sharp , Sripal Bangalore
{"title":"Editorial: Improving outcomes in High Risk PE - a glimpse of the future?","authors":"Andrew Sharp , Sripal Bangalore","doi":"10.1016/j.carrev.2024.08.019","DOIUrl":"10.1016/j.carrev.2024.08.019","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 62-63"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142298651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2025.01.001
Spencer B. King III
{"title":"Should all patients with severe aortic stenosis have TAVR now?","authors":"Spencer B. King III","doi":"10.1016/j.carrev.2025.01.001","DOIUrl":"10.1016/j.carrev.2025.01.001","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 105-106"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143298391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.08.009
Frederic Bouisset , Javier Escaned , Daniel Munhoz , Takuya Mizukami , Ruiko Seki , Carlos H. Salazar , Jeroen Sonck , Nieves Gonzalo , Bernard De Bruyne , Carlos Collet
{"title":"Microcirculatory status after intravascular lithotripsy: The MARVEL study","authors":"Frederic Bouisset , Javier Escaned , Daniel Munhoz , Takuya Mizukami , Ruiko Seki , Carlos H. Salazar , Jeroen Sonck , Nieves Gonzalo , Bernard De Bruyne , Carlos Collet","doi":"10.1016/j.carrev.2024.08.009","DOIUrl":"10.1016/j.carrev.2024.08.009","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 103-104"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.07.004
Maura Meijer, Federico Oliveri, Martijn J.H. van Oort, Brian O. Bingen, Frank van der Kley, J. Wouter Jukema, Ibtihal Al Amri, J.M. Montero-Cabezas
Background
Coronary artery bypass grafting (CABG) is a cornerstone treatment for coronary artery disease, with the use of saphenous vein grafts (SVGs) being prevalent. However, SVGs are susceptible to high failure rates due to graft inflammation, intimal hyperplasia, and atherosclerosis, leading to a substantial number of patients requiring revascularization. Percutaneous coronary intervention (PCI) of SVGs poses unique challenges, including increased risk of distal embolization and perforation due to the grafts' structure and atherosclerotic nature. The role of intravascular lithotripsy (IVL) in calcific SVG lesions has not been elucidated.
Methods
We retrospectively analyzed four cases of patients treated with IVL for SVG stenosis at Leiden University Medical Centre between May 2019 and December 2023. Quantitative coronary analysis and intravascular ultrasound were utilized to assess procedural success and mid- to long-term clinical outcomes were reported as well.
Results
In all 4 cases, IVL was performed in stent (2 due to calcific in-stent neoatherosclerosis; 2 bail-out due to extrinsic stent calcification). No major adverse cardiovascular events (MACE) were reported during mid- to long-term follow-up. The procedure demonstrated effective calcium cracking, leading to optimal stent expansion and minimal residual stenosis with a low risk of procedural complications.
Conclusions
IVL represents a promising approach for managing calcified peri-stent SVG lesions, showing potential for safe and effective revascularization with minimal complications. These findings suggest that IVL could be incorporated into the treatment paradigm for calcified peri-stent SVG stenosis, warranting further investigation in larger, prospective studies to validate its efficacy and safety.
{"title":"Intravascular lithotripsy for the treatment of peri-stent calcific lesions in saphenous vein grafts: A case series report","authors":"Maura Meijer, Federico Oliveri, Martijn J.H. van Oort, Brian O. Bingen, Frank van der Kley, J. Wouter Jukema, Ibtihal Al Amri, J.M. Montero-Cabezas","doi":"10.1016/j.carrev.2024.07.004","DOIUrl":"10.1016/j.carrev.2024.07.004","url":null,"abstract":"<div><h3>Background</h3><div>Coronary artery bypass grafting (CABG) is a cornerstone treatment for coronary artery disease, with the use of saphenous vein grafts (SVGs) being prevalent. However, SVGs are susceptible to high failure rates due to graft inflammation, intimal hyperplasia, and atherosclerosis, leading to a substantial number of patients requiring revascularization. Percutaneous coronary intervention (PCI) of SVGs poses unique challenges, including increased risk of distal embolization and perforation due to the grafts' structure and atherosclerotic nature. The role of intravascular lithotripsy (IVL) in calcific SVG lesions has not been elucidated.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed four cases of patients treated with IVL for SVG stenosis at Leiden University Medical Centre between May 2019 and December 2023. Quantitative coronary analysis and intravascular ultrasound were utilized to assess procedural success and mid- to long-term clinical outcomes were reported as well.</div></div><div><h3>Results</h3><div>In all 4 cases, IVL was performed in stent (2 due to calcific in-stent neoatherosclerosis; 2 bail-out due to extrinsic stent calcification). No major adverse cardiovascular events (MACE) were reported during mid- to long-term follow-up. The procedure demonstrated effective calcium cracking, leading to optimal stent expansion and minimal residual stenosis with a low risk of procedural complications.</div></div><div><h3>Conclusions</h3><div>IVL represents a promising approach for managing calcified peri-stent SVG lesions, showing potential for safe and effective revascularization with minimal complications. These findings suggest that IVL could be incorporated into the treatment paradigm for calcified peri-stent SVG stenosis, warranting further investigation in larger, prospective studies to validate its efficacy and safety.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 85-91"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.07.019
Francesco Costa , Mamas Mamas
{"title":"Editorial: Does troponin I overestimate periprocedural myocardial infarction more than troponin T in PCI patients? The devil is in the details","authors":"Francesco Costa , Mamas Mamas","doi":"10.1016/j.carrev.2024.07.019","DOIUrl":"10.1016/j.carrev.2024.07.019","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 20-22"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141842165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.05.035
Jacob Lee , Suma Gondi , Kristina Gifft , Jinli Wang , Venugopal Bhattad , Chirag Bavishi , Poorna R. Karuparthi , Arun Kumar , Albert Chan , Hitoshi Matsukage , Taishi Hirai
Background
The effect of standardizing an insertion and removal protocol for pVAD devices has not been previously described.
Objectives
We sought to evaluate clinical outcomes in patients who underwent pVAD insertion pre- and post-protocol standardization.
Methods
All patients who underwent pVAD insertion that remained in place at index procedure completion between January 2017 and September 2023 at a single academic center for both high-risk PCI and cardiogenic shock indications were included in the study. The primary outcome was the incidence of limb ischemia and major bleeding before and after the protocol initiation. Secondary outcomes included in-hospital and 30-day MACCE rate (death, myocardial infarction, stroke, emergent CABG), and how often the operators followed the protocol.
Results
A total of 89 patients had pVAD left in place (29 pre-protocol initiation and 60 post-protocol initiation). There was a significant decrease in incidence of limb ischemia post-protocol initiation compared to pre (17.2 % vs 1.7 %, p = 0.01) but no difference in bleeding incidence (13.8 % vs 20.0 %, p = 0.47). Adherence increased in all components of the protocol except for right heart catheterization.
Conclusion
Standardization of an insertion and removal protocol for pVAD devices led to a statistically significant decrease in limb ischemia in a high-risk patient population.
{"title":"The effect of standardization of insertion and removal of percutaneous left ventricular assist device","authors":"Jacob Lee , Suma Gondi , Kristina Gifft , Jinli Wang , Venugopal Bhattad , Chirag Bavishi , Poorna R. Karuparthi , Arun Kumar , Albert Chan , Hitoshi Matsukage , Taishi Hirai","doi":"10.1016/j.carrev.2024.05.035","DOIUrl":"10.1016/j.carrev.2024.05.035","url":null,"abstract":"<div><h3>Background</h3><div>The effect of standardizing an insertion and removal protocol for pVAD devices has not been previously described.</div></div><div><h3>Objectives</h3><div>We sought to evaluate clinical outcomes in patients who underwent pVAD insertion pre- and post-protocol standardization.</div></div><div><h3>Methods</h3><div><span>All patients who underwent pVAD insertion that remained in place at index procedure completion between January 2017 and September 2023 at a single academic center for both high-risk PCI and cardiogenic shock indications were included in the study. The primary outcome was the incidence of </span>limb ischemia<span> and major bleeding before and after the protocol initiation. Secondary outcomes included in-hospital and 30-day MACCE rate (death, myocardial infarction, stroke, emergent CABG), and how often the operators followed the protocol.</span></div></div><div><h3>Results</h3><div><span>A total of 89 patients had pVAD left in place (29 pre-protocol initiation and 60 post-protocol initiation). There was a significant decrease in incidence of limb ischemia post-protocol initiation compared to pre (17.2 % vs 1.7 %, </span><em>p</em> = 0.01) but no difference in bleeding incidence (13.8 % vs 20.0 %, <em>p</em><span> = 0.47). Adherence increased in all components of the protocol except for right heart catheterization.</span></div></div><div><h3>Conclusion</h3><div>Standardization of an insertion and removal protocol for pVAD devices led to a statistically significant decrease in limb ischemia in a high-risk patient population.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 64-68"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141285021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.06.019
Mohsin Sheraz Mughal , Hasan M. Mirza , Amit Bansal , Sundeep Kumar , Ali Ghani , Alon Yarkoni , Fahad Waqar , Najam Wasty , Afzal Rehman
Background
Transcatheter aortic valve replacement (TAVR) can be complicated by anemia due to periprocedural bleeding, hemolysis, vascular events, or significant bleeding associated with antiplatelet therapy.
Objective
We used the National Inpatient Sample (NIS) database to study the outcomes of patients who underwent TAVR and developed significant anemia requiring red blood cell (RBC) transfusion.
Methods
This is a retrospective cohort study utilizing the NIS database from 2016 to 2017. We identified patients who underwent TAVR and required RBC transfusion using ICD-10 and PCS-10 codes. The primary outcome was all-cause inpatient mortality, and the secondary outcomes were the cost of hospitalization and length of stay (LOS). Student t-test, Chi-square, and ANOVA were utilized for statistical analysis where applicable. Multivariate logistic regression was used to adjust for potential confounders. STATA 15.0 was utilized for data analysis.
Results
A total of 18,325 patients underwent TAVR in 2016–2017. Among them, 6.7 % of patients required RBC transfusion. Patients were relatively older in the transfusion group (81 yrs vs 79 yrs; p < 0.001). The mean cost of hospitalization was higher in the transfusion group (283,153 USD vs 208,939 USD; p < 0.001). The mean length of stay (LOS) was higher in the transfusion group (9.0 days vs 4.3 days; p < 0.001). Patients in the transfusion group had higher inpatient all-cause mortality compared to patients without transfusion (6.1 % vs 1.3 %; odds ratio 4.94; p < 0.001, 95 % CI 3.7–6.4). Inpatient mortality and LOS didn't differ by race or sex in the transfusion group. All-cause mortality, LOS, and cost of hospitalization were independently increased by transfusion after adjusting for potential confounders i.e. sex, race, hospital teaching status, hospital region, heart block, pacemaker, arrhythmias, heart failure, diabetes, pulmonary hypertension, CKD, and others using multivariate logistic regression.
Conclusion
In patients undergoing TAVR, blood transfusion was associated with adverse outcomes including increased mortality, length of stay, and cost of hospitalization. The role of careful patient selection, judicious use of antiplatelets, anticoagulants, and pre-procedural optimization of anemia needs further investigation to optimize patient outcomes.
背景：经导管主动脉瓣置换术（TAVR经导管主动脉瓣置换术（TAVR）可能因围手术期出血、溶血、血管事件或与抗血小板治疗相关的严重出血而并发贫血：我们利用全国住院病人抽样（NIS）数据库研究了接受 TAVR 并出现需要输注红细胞（RBC）的严重贫血患者的预后：这是一项利用2016年至2017年NIS数据库进行的回顾性队列研究。我们使用 ICD-10 和 PCS-10 编码识别了接受 TAVR 并需要输注红细胞的患者。主要结果是全因住院死亡率，次要结果是住院费用和住院时间（LOS）。统计分析采用学生 t 检验、卡方检验和方差分析（如适用）。多变量逻辑回归用于调整潜在的混杂因素。数据分析采用 STATA 15.0：2016-2017年，共有18325名患者接受了TAVR。其中，6.7%的患者需要输注RBC。输血组患者的年龄相对较大（81 岁 vs 79 岁；P 结论：输血组患者的年龄相对较大：在接受 TAVR 的患者中，输血与不良后果相关，包括死亡率、住院时间和住院费用的增加。为优化患者预后，需要进一步研究谨慎选择患者、合理使用抗血小板、抗凝药物和术前优化贫血的作用。
{"title":"Outcomes in transcatheter aortic valve replacement (TAVR) patients requiring red blood cell transfusion: A nationwide perspective","authors":"Mohsin Sheraz Mughal , Hasan M. Mirza , Amit Bansal , Sundeep Kumar , Ali Ghani , Alon Yarkoni , Fahad Waqar , Najam Wasty , Afzal Rehman","doi":"10.1016/j.carrev.2024.06.019","DOIUrl":"10.1016/j.carrev.2024.06.019","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Transcatheter aortic valve replacement<span> (TAVR) can be complicated by anemia due to periprocedural </span></span>bleeding, hemolysis, vascular events, or significant bleeding associated with </span>antiplatelet therapy.</div></div><div><h3>Objective</h3><div>We used the National Inpatient Sample (NIS) database to study the outcomes of patients who underwent TAVR and developed significant anemia requiring red blood cell (RBC) transfusion.</div></div><div><h3>Methods</h3><div><span>This is a retrospective cohort study utilizing the NIS database from 2016 to 2017. We identified patients who underwent TAVR and required RBC transfusion using ICD-10 and PCS-10 codes. The primary outcome was all-cause inpatient mortality, and the secondary outcomes were the cost of hospitalization and length of stay (LOS). Student </span><em>t</em><span>-test, Chi-square, and ANOVA were utilized for statistical analysis where applicable. Multivariate logistic regression was used to adjust for potential confounders. STATA 15.0 was utilized for data analysis.</span></div></div><div><h3>Results</h3><div><span>A total of 18,325 patients underwent TAVR in 2016–2017. Among them, 6.7 % of patients required RBC transfusion. Patients were relatively older in the transfusion group (81 yrs vs 79 yrs; p < 0.001). The mean cost of hospitalization was higher in the transfusion group (283,153 USD vs 208,939 USD; p < 0.001). The mean length of stay (LOS) was higher in the transfusion group (9.0 days vs 4.3 days; p < 0.001). Patients in the transfusion group had higher inpatient all-cause mortality compared to patients without transfusion (6.1 % vs 1.3 %; odds ratio 4.94; p < 0.001, 95 % CI 3.7–6.4). Inpatient mortality and LOS didn't differ by race or sex in the transfusion group. All-cause mortality, LOS, and cost of hospitalization were independently increased by transfusion after adjusting for potential confounders i.e. sex, race, hospital teaching status, hospital region, heart block, pacemaker, arrhythmias, heart failure, diabetes, pulmonary hypertension, </span>CKD, and others using multivariate logistic regression.</div></div><div><h3>Conclusion</h3><div><span>In patients undergoing TAVR, blood transfusion was associated with </span>adverse outcomes<span> including increased mortality, length of stay, and cost of hospitalization. The role of careful patient selection, judicious use of antiplatelets, anticoagulants, and pre-procedural optimization of anemia needs further investigation to optimize patient outcomes.</span></div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 50-53"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.08.012
Placido Maria Mazzone, Davide Capodanno
{"title":"Editorial: C-reactive protein and TAVR: Impact of inflammation on patient outcomes","authors":"Placido Maria Mazzone, Davide Capodanno","doi":"10.1016/j.carrev.2024.08.012","DOIUrl":"10.1016/j.carrev.2024.08.012","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 76-77"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082144","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-01DOI: 10.1016/j.carrev.2024.05.040
Ancy Jenil Franco , Mrinal Murali Krishna , Meghna Joseph , Chidubem Ezenna , Zeynep Eylul Bakir , Renan Yuji Ura Sudo , Catherine Wegner Wippel , Mahmoud Ismayl , Andrew M. Goldsweig , Ilayaraja Uthirapathy
Background
Culprit-only percutaneous coronary intervention (PCI) is commonly performed for acute coronary syndrome (ACS) with multivessel coronary artery disease (MVD) in the elderly. Complete revascularization has been shown to benefit the general population, yet its safety and efficacy in older patients are uncertain.
Methods
Following PRISMA guidelines, we systematically searched PubMed, Embase, and Cochrane databases for randomized controlled trials (RCTs) comparing complete versus culprit-only PCI in patients ≥65 years old with ACS and MVD. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included myocardial infarction (MI), ischemia-driven revascularization (IDR), all-cause mortality, and cardiovascular mortality. Data were pooled using a random effects model with a restricted maximum likelihood estimator to generate risk ratios (RRs).
Results
Five RCTs with 4105 patients aged ≥65 years were included. Compared with culprit-only PCI, complete revascularization reduced MI (RR 0.65; 95 % CI 0.49–0.85; p < 0.01). MACE (RR 0.75; 95 % CI 0.54–1.05; p = 0.09) and IDR (RR 0.41; 95 % CI 0.16–1.04; p = 0.06) were not significantly different between both strategies among those aged ≥65. However, there was a significant reduction in MI (RR 0.69; 95 % CI 0.49–0.96; p-value = 0.03), MACE (RR 0.78; 95 % CI 0.65–0.94; p < 0.01), and IDR (RR 0.60; 95 % CI 0.41–0.89; p < 0.01) in those aged ≥75.
Conclusions
In elderly patients aged ≥65 years with ACS and MVD, a strategy of complete revascularization by PCI reduces MI compared to culprit-only PCI with no significant difference in MACE and IDR. However, complete revascularization reduced MI, MACE, and IDR in those aged ≥75 years suggesting a possible benefit in this age group.
{"title":"Complete versus culprit-only percutaneous coronary intervention in elderly patients with acute coronary syndrome and multivessel coronary artery disease: A systematic review and meta-analysis","authors":"Ancy Jenil Franco , Mrinal Murali Krishna , Meghna Joseph , Chidubem Ezenna , Zeynep Eylul Bakir , Renan Yuji Ura Sudo , Catherine Wegner Wippel , Mahmoud Ismayl , Andrew M. Goldsweig , Ilayaraja Uthirapathy","doi":"10.1016/j.carrev.2024.05.040","DOIUrl":"10.1016/j.carrev.2024.05.040","url":null,"abstract":"<div><h3>Background</h3><div>Culprit-only percutaneous coronary intervention (PCI) is commonly performed for acute coronary syndrome<span> (ACS) with multivessel coronary artery disease<span> (MVD) in the elderly. Complete revascularization has been shown to benefit the general population, yet its safety and efficacy in older patients are uncertain.</span></span></div></div><div><h3>Methods</h3><div><span><span>Following PRISMA guidelines, we systematically searched PubMed, Embase, and Cochrane databases for </span>randomized controlled trials<span> (RCTs) comparing complete versus culprit-only PCI in patients ≥65 years old with ACS and MVD. The primary outcome was major adverse cardiovascular events (MACE). Secondary outcomes included myocardial infarction (MI), ischemia-driven revascularization (IDR), all-cause mortality, and cardiovascular mortality. Data were pooled using a random effects model with a restricted </span></span>maximum likelihood estimator to generate risk ratios (RRs).</div></div><div><h3>Results</h3><div>Five RCTs with 4105 patients aged ≥65 years were included. Compared with culprit-only PCI, complete revascularization reduced MI (RR 0.65; 95 % CI 0.49–0.85; <em>p</em> < 0.01). MACE (RR 0.75; 95 % CI 0.54–1.05; <em>p</em> = 0.09) and IDR (RR 0.41; 95 % CI 0.16–1.04; <em>p</em> = 0.06) were not significantly different between both strategies among those aged ≥65. However, there was a significant reduction in MI (RR 0.69; 95 % CI 0.49–0.96; <em>p</em>-value = 0.03), MACE (RR 0.78; 95 % CI 0.65–0.94; <em>p</em> < 0.01), and IDR (RR 0.60; 95 % CI 0.41–0.89; p < 0.01) in those aged ≥75.</div></div><div><h3>Conclusions</h3><div>In elderly patients aged ≥65 years with ACS and MVD, a strategy of complete revascularization by PCI reduces MI compared to culprit-only PCI with no significant difference in MACE and IDR. However, complete revascularization reduced MI, MACE, and IDR in those aged ≥75 years suggesting a possible benefit in this age group.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"70 ","pages":"Pages 1-9"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141279886","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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