ISSN 1671-5411 CN 11-5329/R
Xiao-Fan YU, Yi LI, Qian-Cheng WANG, Xiao-Zeng WANG, Ming LIANG, Xin ZHAO, Kai XU, Ya-Ling HAN. Staged versus “one-time” multivessel intervention in elderly patients with non-ST-elevation acute coronary syndrome. J Geriatr Cardiol 2016; 13(9): 760-767. doi: 10.11909/j.issn.1671-5411.2016.09.004
Citation: Xiao-Fan YU, Yi LI, Qian-Cheng WANG, Xiao-Zeng WANG, Ming LIANG, Xin ZHAO, Kai XU, Ya-Ling HAN. Staged versus “one-time” multivessel intervention in elderly patients with non-ST-elevation acute coronary syndrome. J Geriatr Cardiol 2016; 13(9): 760-767. doi: 10.11909/j.issn.1671-5411.2016.09.004

Staged versus “one-time” multivessel intervention in elderly patients with non-ST-elevation acute coronary syndrome

doi: 10.11909/j.issn.1671-5411.2016.09.004
  • Received Date: 2016-01-04
  • Rev Recd Date: 2016-03-08
  • Publish Date: 2016-09-28
  • Objective To evaluate the clinical outcomes of “one-time” versus staged multivessel stenting in elderly (≥ 60 years) patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) and multivessel disease (MVD). Methods We analyzed data of consecutive NSTE-ACS patients with multivessel percutaneous coronary intervention (PCI) who were enrolled in General Hospital of Shenyang Military Region between 2008 and 2012. A total of 1090 eligible patients aged ≥ 60 were further categorized into “one-time” group (n = 623) and staged PCI group (n = 467) according to intervention strategy. The primary endpoint was composite outcome of myocardial infarction (MI) or cardiac death during 3-year follow-up. Results The estimated 3-year composite rate of cardiac death or MI was 7.0% in the staged PCI group and 9.5% in the “one-time” group (P = 0.110). Multivariate analysis confirmed the benefit of staged PCI on the primary events in the elderly (HR: 0.638, 95% CI: 0.408 –0.998, P = 0.049). In a propensity score matched cohort, staged PCI was associated with lower rates of primary events (6.1% vs. 10.4%, P = 0.046) and MI (3.4% vs. 7.4%, P = 0.037) at three years. In addition, there were reduced trends in the stent thrombosis at 30 days (0.3% vs. 1.4%, P = 0.177) and at three years (1.1% vs. 2.4%, P = 0.199) in the staged PCI group. There was no significant difference in the 3-year target vessel revascularization (15.5% vs. 14.4%, P = 0.746). Conclusions In elderly NSTE-ACS patients with MVD, staged PCI might be an optimal strategy associated with reduced long-term cardiac death or MI compared with “one-time” PCI strategy, which needs further confirmation.
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