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Long‐term outcomes and predictors of morbi‐mortality according to age in stemi patients with multivessel disease: Impact of an incomplete revascularization
Author(s) -
Rumiz Eva,
Berenguer Alberto,
Vilar Juan Vicente,
Valero Ernesto,
Facila Lorenzo,
Cubillos Andres,
Sanmiguel Dario,
Almela Pablo,
Morell Salvador
Publication year - 2018
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.27691
Subject(s) - mace , medicine , myocardial infarction , revascularization , cardiology , incidence (geometry) , ejection fraction , angioplasty , population , percutaneous coronary intervention , heart failure , physics , environmental health , optics
Background Optimal management strategy for patients with ST‐segment elevation myocardial infarction (STEMI) and multivessel disease (MVD) still remains unclear, especially in the elderly population. The aim of this study was to assess long‐term outcomes and predictors of morbi‐mortality according to age in patients with a STEMI and MVD. Methods We prospectively included 381 consecutive patients with a STEMI who underwent primary angioplasty and showed MVD in the angiogram. 111 (29.1%) patients were older than 75 (≥75) years and 270 (70.9%) were younger than 75 (<75) years. The co‐primary outcomes were the incidence of all‐cause mortality and major adverse cardiac events (MACE) during follow‐up. Results During a median follow‐up of 22 months, patients ≥75 years showed a higher incidence of all‐cause mortality and MACE, as compared to younger patients. On multivariate analysis, incomplete revascularization (IR) was only an independent predictor of MACE (HR = 3.1, CI 95%:1.9‐4.7; P = .02) in younger patients; whereas in the elderly group severely depressed ejection fraction was the unique independent predictor of MACE (HR = 2.7, CI 95%:1.5‐4.8; P = .001). IR was not associated with the risk of all‐cause mortality in any group. Conclusion This study confirms the relevant prevalence of MVD in STEMI patients, as well as the difference in outcomes of an IR strategy between both age‐groups, being only independently associated with MACE in younger patients. This finding supports that a routine complete revascularization (CR) strategy seems to be the best therapeutic option in younguer patients, whereas in the elderly population may not confer a clear clinical benefit during a long‐term follow‐up.