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Meta-Analysis
. 2024 Apr 12;24(1):337.
doi: 10.1186/s12877-024-04896-4.

Predictors of major adverse cardiac and cerebrovascular events after percutaneous coronary intervention in older adults: a systematic review and meta-analysis

Arash Jalali #  1   2 , Ali Hassanzadeh #  3 , Mohammad Sadeq Najafi  4 , Sepehr Nayebirad  1 , Mohadese Dashtkoohi  5 , Zahra Karimi  1   2 , Akbar Shafiee  6
Affiliations
Meta-Analysis

Predictors of major adverse cardiac and cerebrovascular events after percutaneous coronary intervention in older adults: a systematic review and meta-analysis

Arash Jalali et al. BMC Geriatr. .

Abstract

Aim: We systematically reviewed and meta-analyzed the predictors of major adverse cardiac and cerebrovascular events (MACE/MACCE) in older adults who underwent PCI.

Methods: Three databases, PubMed, Embase, and Scopus, were searched for observational studies considering the out-of-hospital MACE/MACCE in adults ≥ 60 years old with coronary artery disease (acute or chronic) who underwent PCI. Studies were eligible if they had determined at least two statistically significant predictors of MACE/MACCE by multivariable analysis. We used the QUIPS tool to evaluate the risk of bias in the studies. Random-effects meta-analysis was utilized to pool the hazard ratios (HRs) of the most reported predictors.

Results: A total of 34 studies were included in the review. Older age (HR = 1.04, 95% Confidence Interval (CI): 1.03-1.06, P-value < 0.001), diabetes (HR = 1.36, 95% CI: 1.22-1.53, P < 0.001), history of myocardial infarction (MI) (HR = 1.88, 95% CI: 1.37-2.57, P < 0.001), ST-elevation MI (STEMI) at presentation (HR = 1.72, 95% CI: 1.37-2.18, P < 0.001), reduced left ventricular ejection fraction (LVEF) (HR = 2.01, 95% CI: 1.52-2.65, P < 0.001), successful PCI (HR = 0.35, 95% CI: 0.27-0.47, P < 0.001), eGFR (HR = 0.99, 95% CI: 0.97-1.00; P-value = 0.04) and left main coronary artery (LMCA) disease (HR = 2.07, 95% CI: 1.52-2.84, P < 0.001) were identified as predictors of MACE.

Conclusion: We identified older age, diabetes, history of MI, STEMI presentation, lower LVEF, and LMCA disease increased the risk of MACE/MACCE after PCI in older adults. Meanwhile, higher eGFR and successful PCI predicted lower adverse events risk. Future studies should focus on a more robust methodology and a precise definition of MACE.

Registration: PROSPERO (CRD42023480332).

Keywords: Coronary artery disease; Major adverse cardiac events; Older adults; Percutaneous coronary intervention.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for study selection
Fig. 2
Fig. 2
Summary of risk of bias assessment of the included studies using QUIPS
Fig. 3
Fig. 3
Forest plots of demographic and clinical predictors of MACE/MACCE. Abbreviations: MI: myocardial infarction, STEMI: ST elevation MI
Fig. 4
Fig. 4
Forest plots of paraclinical and procedural predictors of MACE/MACCE. Abbreviations: LVEF: left ventricular ejection fraction, eGFR: estimated glomerular filtration rate, PCI: percutaneous coronary intervention, DES: drug-eluting stents, LMCA: left main coronary artery
See this image and copyright information in PMC

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