Clinical impact of complete revascularization in elderly patients with multi-vessel coronary artery disease undergoing percutaneous coronary intervention: A sub-analysis of the SHINANO registry

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• 作者：Mikiko Harada^a ; ^b ; ^{m02039mk@jichi.ac.jp} ; Takashi Miura^a ; Takahiro Kobayashi^c ; Hideki Kobayashi^a ; Masanori Kobayashi^d ; Hiroyuki Nakajima^e ; Hikaru Kimura^f ; Hiroshi Akanuma^g ; Eiichiro Mawatari^h ; Toshio Satoⁱ ; Shoji Hotta^j ; Yuichi Kamiyoshi^k ; Takuya Maruyama^l ; Noboru Watanabe^m ; Takayuki Eisawaⁿ ; Naoto Hashizume^l ; Soichiro Ebisawa^a ; Yusuke Miyashita^o ; Uichi Ikeda^a ; ^c ; On behalf of the SHINANO registry investigators
• 关键词：CR ; complete revascularization ; ICR ; incomplete revascularization ; PCI ; percutaneous coronary intervention ; CAD ; coronary artery disease ; STEMI ; ST-segment elevated myocardial infarction ; NSTEMI ; non-ST-segment elevated myocardial infarction ; UA ; unstable angina ; MACE ; major adverse cardiovascular events ; MI ; myocardial infarction ; IHD ; ischemic heart disease ; HF ; heart failure ; QOL ; quality of life ; ACS ; acute coronary syndrome ; CABG ; coronary artery bypass surgery ; BP ; blood pressure ; BMI ; bod
• 刊名：International Journal of Cardiology
• 出版年：2017
• 出版时间：1 March 2017
• 年：2017
• 卷：230
• 期：Complete
• 页码：413-419
• 全文大小：611 K
• 卷排序：230

文摘

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 (≥ 75 years old) with multi-vessel CAD.MethodsThe 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).ResultsOf 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&ndash;4.80; p = 0.007, HR, 0.40; 95% CI, 0.20&ndash;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).ConclusionsEven in elderly patients over 75 years old with multi-vessel CAD, CR-PCI appears to suppress mid-term ischemic events.