ArticleInternational journal of cardiology. Heart & vasculature2025
Association of complete revascularization with safety and outcomes in elderly patients with multi-vessel coronary artery disease: a systematic review and meta-analysis.
Article in International journal of cardiology. Heart & vasculature, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The utility of complete revascularization has been well defined in young patients with acute coronary syndrome (ACS) and multivessel coronary artery disease (CAD). However, the clinical benefit in elderly patients remains unclear with current literature has yielded conflicting results. This meta-analysis aims to evaluate the association of complete versus culprit-only coronary revascularization with mortality in elderly patients with multivessel CAD. Methods: A literature search was conducted for studies reporting on outcomes after complete versus culprit-only revascularization in elderly patients with multivessel CAD presenting with ACS. The primary endpoint was all-cause mortality. The main secondary endpoint was cardiovascular (CV) mortality. The search included the following databases: PubMed, EMBASE, and Web of Science. The search was not restricted to time or publication status. Results: 14 studies with 11,994 elderly patients (7,236 with culprit-only, 4,758 with complete revascularization) met inclusion criteria. Mean follow-up duration was 29.0 months (range 12-56 months), mean age was 79.5 years old, 56.9% of patients were men, and mean left ventricular ejection fraction was 54.3%. Patients who underwent complete revascularization had significantly lower all-cause and CV mortality compared to culprit-only revascularization (OR 1.75, 95% CI 1.40-2.18; p < 0.001; OR 1.75, 95% CI 1.14-2.68; p = 0.01). Subgroup analysis demonstrated this association to be statistically significant for studies with cohorts presenting with non-ST segment elevation myocardial infarction (NSTEMI) and mixed cohorts that included NSTEMI and ST segment elevation myocardial infarction (STEMI) patients. However, there was no significant difference in risk of all-cause mortality with complete versus culprit-only revascularization in studies of only STEMI patients (OR 1.03, 95% CI 0.61-1.72; p = 0.92). Conclusion: Complete coronary revascularization is associated with lower risk of all-cause and CV mortality in elderly patients with multivessel CAD presenting with NSTEMI. However, there does not appear to be a difference in outcomes in patients presenting with STEMI.
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