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Complete Versus Culprit-Only Revascularization in Older Patients With ST-Segment-Elevation Myocardial Infarction: An Individual Patient Meta-Analysis
G. Campo, F. Böhm, T. Engstrøm, PC. Smits, IY. Elgendy, GP. McCann, DA. Wood, M. Serenelli, S. James, DE. Høfsten, BM. Boxm-de Klerk, A. Banning, JA. Cairns, R. Pavasini, G. Stankovic, P. Kala, H. Kelbæk, E. Barbato, I. Srdanovic, M. Hamza, AS....
Language English Country United States
Document type Journal Article, Meta-Analysis
NLK
Free Medical Journals
from 1950 to 1 year ago
Open Access Digital Library
from 1950-01-01
Open Access Digital Library
from 1950-01-01
- MeSH
- ST Elevation Myocardial Infarction * mortality surgery therapy MeSH
- Percutaneous Coronary Intervention mortality MeSH
- Humans MeSH
- Randomized Controlled Trials as Topic * MeSH
- Myocardial Revascularization * methods MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Age Factors MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
BACKGROUND: Complete revascularization is the standard treatment for patients with ST-segment-elevation myocardial infarction and multivessel disease. The FIRE trial (Functional Assessment in Elderly Myocardial Infarction Patients With Multivessel Disease) confirmed the benefit of complete revascularization in a population of older patients, but the follow-up is limited to 1 year. Therefore, the long-term benefit (>1 year) of this strategy in older patients is debated. To address this, an individual patient data meta-analysis was conducted in patients with ST-segment-elevation myocardial infarction ≥75 years of age enrolled in randomized clinical trials investigating complete versus culprit-only revascularization strategies. METHODS: PubMed, Embase, and the Cochrane database were systematically searched to identify randomized clinical trials comparing complete versus culprit-only revascularization. Individual patient-level data were collected from the relevant trials. The primary end point was death, myocardial infarction, or ischemia-driven revascularization. The secondary end point was cardiovascular death or myocardial infarction. RESULTS: Data from 7 randomized clinical trials encompassing 1733 patients (917 randomized to culprit-only and 816 to complete revascularization) were analyzed. The median age was 79 [interquartile range, 77-83] years. Of the patients, 595 (34%) were female. Follow-up ranged from a minimum of 6 months to a maximum of 6.2 years (median, 2.5 [interquartile range, 1-3.8] years). Complete revascularization reduced the primary end point up to 4 years (hazard ratio, 0.78 [95% CI, 0.63-0.96]) but not at the longest available follow-up (hazard ratio, 0.83 [95% CI, 0.69-1.01]). Complete revascularization significantly reduced the occurrence of cardiovascular death or myocardial infarction at the longest available follow-up (hazard ratio, 0.76 [95% CI, 0.58-0.99]). This was observed even when censoring the follow-up at each year. Long-term rate of death did not differ between complete and culprit-only revascularization arms. CONCLUSIONS: In this individual patient data meta-analysis of older patients with ST-segment-elevation myocardial infarction and multivessel disease, complete revascularization reduced the primary end point of death, myocardial infarction, or ischemia-driven revascularization up to 4 years. At the longest follow-up, complete revascularization reduced the composite of cardiovascular death or myocardial infarction but not the primary end point. REGISTRATION: URL: https://www.crd.york.ac.uk/prospero/; Unique identifier: CRD42022367898.
Cardiology Department Maasstad Hospital Rotterdam The Netherlands
Cardiology Unit Azienda Ospedaliero Universitaria di Ferrara Cona Italy
Centre for Heart Valve Innovation St Paul's Hospital University of British Columbia Vancouver Canada
Department of Cardiology Ain Shams University Cairo Egypt
Department of Cardiology Heart Centre Copenhagen University Hospital Rigshospitalet Denmark
Department of Cardiology Karolinska Institute and Danderyd Hospital Sweden
Department of Cardiology Rigshospitalet University of Copenhagen Denmark
Department of Cardiology Zealand University Hospital Roskilde Denmark
Department of Clinical and Molecular Medicine Sapienza University of Rome Italy
Department of Medical Sciences Uppsala University Sweden
Division of Cardiovascular Medicine Gill Heart Institute University of Kentucky Lexington
Oxford Heart Centre Oxford University Hospitals NHS Trust United Kingdom
Population Health Research Institute Hamilton Health Sciences and McMaster University Canada
Statistics and Education Franciscus Gasthuis en Vlietland Rotterdam The Netherlands
University Hospital Brno Medical Faculty of Masaryk University Brno Czech Republic
References provided by Crossref.org
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