Long term prognostic benefit of complete revascularization in elderly presenting with NSTEMI: real world evidence

Rev Cardiovasc Med. 2021 Jun 30;22(2):475-482. doi: 10.31083/j.rcm2202054.

Abstract

The benefit of complete revascularization in elderly patients with non-ST elevation myocardial infarction (NSTEMI), and multivessel disease remains debated (MVD). The aim of our study was to determine the current long-term prognostic benefit of complete revascularization in this population. A retrospective cohort study of 1722 consecutive elderly NSTEMI patients was performed. Among the study participants 30.4% (n = 524) were completed revascularizated and in 69.6% (n = 1198) culprit vessel only revascularization was performed. A propensity score analysis was performed and we divided the study population into two groups: complete revascularization (n = 500) and culprit vessel only revascularization (n = 500). The median follow-up was 45.7 months, the all cause mortality (44.5% vs 30.5%, p < 0.001) (HR 0.74 (0.57-0.97); p = 0.035) and cardiovascular mortality (32.6% vs 17.4%, p < 0.001) (HR = 0.67 (0.47-0.94); p = 0.021) were significantly lower in patients with complete revascularization. In our study, we observed a long-term benefit of complete revascularization in elderly NSTEMI and MVD patients. Elderly patients should also be managed according to current guidelines to improve their long-term prognosis.

Keywords: Elderly; Mortality; Revascularization.

MeSH terms

  • Aged
  • Coronary Artery Disease* / diagnostic imaging
  • Coronary Artery Disease* / surgery
  • Humans
  • Myocardial Revascularization
  • Non-ST Elevated Myocardial Infarction* / diagnostic imaging
  • Non-ST Elevated Myocardial Infarction* / surgery
  • Percutaneous Coronary Intervention* / adverse effects
  • Prognosis
  • Retrospective Studies
  • ST Elevation Myocardial Infarction*
  • Treatment Outcome