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Incomplete revascularization in the drug eluting stent era permits meaningful long-term (12-78 months) outcomes in patients ≥ 75 years with acute coronary syndrome

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Author(s): Jie Chen | Qiao Xue | Jing Bai | Lei Gao | Jin-Wen Tian | Ke Li | Qiang Xu | Yan-Hua Li | Yu Wang

Journal: Journal of Geriatric Cardiology
ISSN 1671-5411

Volume: 9;
Issue: 4;
Start page: 336;
Date: 2012;
Original page

Keywords: Elderly patients | Percutaneous Coronary Intervention | Incomplete Revascularization | Long-term Prognosis

ABSTRACT
ObjectiveTo compare long-term prognosis between complete revascularization (CR) and incomplete revascularization (IR) in eld¬erly patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Methods We prospectively enrolled patients ≥ 75 years with ACS and multi-lesion disease between January 2005 and December 2010 at our center (Institute of Geriatric Cardiology, Chinese PLA General Hospital). Baseline clinical characteristics, PCI parameters and long-term (12 to 78 months) outcomes including main adverse cardiac and cerebral events (MACCE) were compared between CR and IR groups. We used the Kaplan-Meier curve to describe the survival rates, and variables reported to be associated with prognosis were included in Cox regression. Results Of the 502 patients, 230 patients obtained CR, and the other 272 patients underwent IR. Higher SYNTAX score was an independent predictor of IR [Odds ratio (OR): 1.141, 95% confidence interval (95% CI): 1.066–1.221, P = 0.000]. A total of 429 patients (85.5%) were followed with a duration ranging from 12 months to 78 months. There were no significant differences in cumulative survival rates and event free survival rates between the two groups, even for patients with multi-vessel disease. Older age (OR: 1.079, 95% CI: 1.007–1.157, P = 0.032), prior myocardial infarction (OR: 1.440, 95% CI: 1.268–2.723, P = 0.001) and hypertension (OR: 1. 653, 95% CI: 1.010-2.734, P = 0.050) were significant independent predictors of long-term MACCE. Conclusions Given that both clinical and coronary lesion characteristics are much more complex in patients ≥75 years with ACS and multi-lesion disease, IR may be an option allowing low risk hospital results and meaningful long-term (12 to 78 months) outcomes.
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