Multivessel coronary disease is frequent in older patients who underwent coronary
angiography for acute coronary syndrome. Whether a complete revascularization or a
culprit-only approach is preferable in these patients is still debated. We included
consecutive patients aged ≥85 years, presenting with acute coronary syndrome and showing
multivessel coronary disease at coronary angiography. Patients were grouped according
to complete (residual SYNTAX score [RSS] 0 to 8) or incomplete (RSS >8) revascularization.
Primary end point was the rate of major adverse cardiovascular events (MACEs, the
composite of cardiovascular death, re-myocardial infarction [re-MI], clinically driven
percutaneous coronary intervention, and rehospitalization because of cardiac disease)
at 2 years follow-up. A total of 166 patients met the criteria for enrollment; 108
patients had a final RSS 0 to 8 (complete revascularization) and 58 patients had a
final RSS >8 (incomplete revascularization). The rate of MACE was reduced in patients
who underwent complete revascularization (35.2% vs 51.7%, p = 0.039, adjusted hazard
ratio 0.60, 95% confidence interval 0.37 to 0.98, p = 0.04), a difference mainly driven
by a reduction in re-MI (8.3% vs 19.0%, p = 0.045), clinically driven percutaneous
coronary intervention (2.8% vs 19.0%, p <0.001), and rehospitalization for cardiac
disease (9.3% vs 24.1%, p = 0.009). Other independent predictors of MACE were active
malignancy, previous MI, left ventricle ejection fraction <35% (increasing risk of
events), and radial access (reducing risk of events). In conclusion, in patients aged
≥85 years, a complete revascularization is associated with a better prognosis, especially
in terms of nonfatal events.
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Article Info
Publication History
Published online: July 26, 2022
Received in revised form:
June 18,
2022
Received:
April 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
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© 2022 Elsevier Inc. All rights reserved.
