Your browser doesn't support javascript.
loading
Effects of complete revascularization according to age in patients with ST-segment elevation myocardial infarction and multivessel disease (COMPLETE-AGE).
Bainey, Kevin R; Wood, David A; Bossard, Matthias; Campo, Gianluca; Cantor, Warren J; Lavi, Shahar; Madan, Mina; Mehran, Roxana; Pinilla-Echeverri, Natalia; Rao, Sunil; Sarma, Jaydeep; Sheth, Tej; Stankovic, Goran; Steg, Phillipe Gabriel; Storey, Robert F; Tanguay, Jean-Francois; Velianou, James L; Welsh, Robert C; Mani, Thenmozhi; Cairns, John A; Mehta, Shamir R.
Afiliação
  • Bainey KR; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
  • Wood DA; University of British Columbia, Vancouver, British Columbia, Canada.
  • Bossard M; Luzerner Kantonsspital, Luzern, Switzerland.
  • Campo G; Azienda Ospedaliero Universitaria di Ferrara, University of Ferrara, Ferrara, Italy.
  • Cantor WJ; Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada.
  • Lavi S; Western University, London Health Sciences Centre, London, Ontario, Canada.
  • Madan M; Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada.
  • Mehran R; The Zena A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY.
  • Pinilla-Echeverri N; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
  • Rao S; NYU Langone Health System, New York, NY.
  • Sarma J; North West Heart Centre, Wythenshawe Hospital, Manchester, United Kingdom.
  • Sheth T; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
  • Stankovic G; University Clinical Center of Serbia and Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
  • Steg PG; Hôpital Bichat, Paris, France.
  • Storey RF; Department of Infection, Immunity, and Cardiovascular Disease, University of Sheffield, Sheffield, United Kingdom.
  • Tanguay JF; Montreal Heart Institute and Universite de Montreal, Montreal, Quebec, Canada.
  • Velianou JL; McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
  • Welsh RC; Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
  • Mani T; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada.
  • Cairns JA; University of British Columbia, Vancouver, British Columbia, Canada.
  • Mehta SR; Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada. Electronic address: smehta@mcmaster.ca.
Am Heart J ; 267: 70-80, 2024 01.
Article em En | MEDLINE | ID: mdl-37871781
ABSTRACT

BACKGROUND:

In ST-segment elevation myocardial infarction (STEMI), complete revascularization with percutaneous coronary intervention (PCI) reduces major cardiovascular events compared with culprit-lesion-only PCI. Whether age influences these results remains unknown.

METHODS:

COMPLETE was a multinational, randomized trial evaluating a strategy of staged complete revascularization, consisting of angiography-guided PCI of all suitable nonculprit lesions, versus a strategy of culprit-lesion-only PCI. In this prespecified subgroup analysis, treatment effect according to age (≥65 years vs <65 years) was determined for the first coprimary outcome of cardiovascular (CV) death or new myocardial infarction (MI) and the second coprimary outcome of CV death, new MI, or ischemia-driven revascularization (IDR). Median follow-up was 35.8 months (interquartile range [IQR] 27.6-44.3 months).

RESULTS:

Of 4,041 patients randomized in COMPLETE, 1,613 were aged ≥ 65 years (39.9%). Higher event rates were observed for both coprimary outcomes in patients aged ≥ 65 years comparted with those aged < 65 years (11.2% vs 7.9%, HR 1.49, 95% CI 1.22-1.83; 14.4% vs 11.8%, HR 1.28, 95% CI 1.07-1.52, respectively). Complete revascularization reduced the first coprimary outcome in patients ≥ 65 years (9.7% vs 12.5%, HR 0.77; 95% CI, 0.58-1.04) and < 65 years (6.7% vs 9.1%, HR 0.72; 95% CI, 0.54-0.96)(interaction P = .74). The second coprimary outcome was reduced in those ≥ 65 years (HR 0.56, 95% CI, 0.43-0.74) and < 65 years (HR 0.48, 95% CI, 0.37-0.61 (interaction P = .37). A sensitivity analysis was performed with consistent results demonstrated using a 75-year threshold (albeit attenuated).

CONCLUSIONS:

In patients with STEMI and multivessel CAD, complete revascularization compared with culprit-lesion-only PCI reduced major cardiovascular events regardless of patient age and could be considered as a revascularization strategy in older adults.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Intervenção Coronária Percutânea / Infarto do Miocárdio com Supradesnível do Segmento ST / Infarto do Miocárdio Limite: Aged / Humans / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Doença da Artéria Coronariana / Intervenção Coronária Percutânea / Infarto do Miocárdio com Supradesnível do Segmento ST / Infarto do Miocárdio Limite: Aged / Humans / Middle aged Idioma: En Ano de publicação: 2024 Tipo de documento: Article