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Review
. 2024 Nov 20;16(11):e74068.
doi: 10.7759/cureus.74068. eCollection 2024 Nov.

Complete Versus Incomplete Revascularization in Elderly Patients With Myocardial Infarction: A Systematic Review and Meta-Analysis

Cesar Intriago  1 , Cristopher-Josué Escudero  2 , Jesús Endara-Mina  2 , Oscar E Dávila  3 , Miriam J Zúñiga  3 , Génesis D Loor  3 , José L Villamarín-Corrales  4 , Juan C Gaibor  5 , Rafael López-Carrera  6 , Luis S Loya  7 , Angélica Lema  8
Affiliations
Review

Complete Versus Incomplete Revascularization in Elderly Patients With Myocardial Infarction: A Systematic Review and Meta-Analysis

Cesar Intriago et al. Cureus. .

Abstract

Coronary artery disease (CAD) is the leading cause of mortality in the United States, and percutaneous coronary intervention (PCI) is established as the standard after an acute episode of CAD. This review assessed the use of complete revascularization (CR) or incomplete revascularization (IR) in older adults, who present a higher cardiovascular risk. The aim is to define the effectiveness of both procedures in this population, focusing on major adverse cardiovascular events (MACE), myocardial infarction (MI), and all-cause mortality (ACM). A literature search identified 15 studies, evaluated using the Risk of Bias 2 (RoB 2) tool and the Risk of Bias in Non-Randomized Studies of Interventions I (ROBINS-I) tool for bias risk. Despite positive results in recent studies, this meta-analysis does not show the superiority of CR, demonstrating a lack of benefit in reducing mortality, myocardial infarction, and adverse events in the ≥ 70-year-old age group.

Keywords: coronary artery disease; coronary revascularization; major adverse cardiovascular events; myocardial infarction; older adults.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. PRISMA flow diagram of study screening and selection.
PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analysis.
Figure 2
Figure 2. Risk of MACE in complete vs incomplete revascularization in elderly patients.
Number of participants per group: Berezhnoi K, et al. [7], n=305; Biscaglia S, et al. [5], n=1445; Kato T, et al. [11], n=39; Lu Y, et al. [6], n=790; Marino M, et al. [8], n=166; Rumiz E, et al. [18], n=111; Song Y, et al. [21], n=269; Wang G, et al. [22], n=1263. CR: complete revascularization; IR: incomplete revascularization; SE: standard error; IV: inverse variance; CI: confidence interval; df: degrees of freedom; I²: heterogeneity (I-squared); Tau²: between-study variance (Tau-squared); Chi²: Chi-squared test; Z: Z-score for overall effect; P-value: statistical significance; MACE: major adverse cardiovascular events.
Figure 3
Figure 3. Risk of all-cause mortality in complete vs incomplete revascularization in elderly patients.
Number of participants per group: Magalhaes M, et al. [19], n=2132; Iqbal M, et al. [14], n=8436; Lu Y, et al. [6], n=790; Wang G, et al. [22], n=1263; Hannan E, et al. [15], n=11294; Wu C, et al. [17], n=8750. CR: complete revascularization; IR: incomplete revascularization; SE: standard error; IV: inverse variance; CI: confidence interval; df: degrees of freedom; I²: heterogeneity (I-squared); Tau²: between-study variance (Tau-squared); Chi²: Chi-squared test; Z: Z-score for overall effect; P-value: statistical significance.
Figure 4
Figure 4. Risk of myocardial infarction in complete vs incomplete revascularization in elderly patients.
Number of participants per group: Biscaglia S, et al. [5], n=1445; Hannan E, et al. [15], n=11294; Lu Y, et al. [6], n=790; Marino M, et al. [8], n=166; Wang G, et al. [22], n=1263. CR: complete revascularization; IR: incomplete revascularization; SE: standard error; IV: inverse variance; CI: confidence interval; df: degrees of freedom; I²: heterogeneity (I-squared); Tau²: between-study variance (Tau-squared); Chi²: Chi-squared test; Z: Z-score for overall effect; P-value: statistical significance.
Figure 5
Figure 5. Risk of MACE in complete vs incomplete revascularization in the subgroup of elderly patients > 80 years old.
Number of participants per group: Berezhnoi K, et al. [7], n=305; Biscaglia S, et al. [5], n=1445; Lu Y, et al. [6], n=790; Marino M, et al. [8], n=166. CR: complete revascularization; IR: incomplete revascularization; SE: standard error; IV: inverse variance; CI: confidence interval; df: degrees of freedom; I²: heterogeneity (I-squared); Tau²: between-study variance (Tau-squared); Chi²: Chi-squared test; Z: Z-score for overall effect; P-value: statistical significance, MACE: major adverse cardiovascular events.
Figure 6
Figure 6. Risk of all-cause of mortality in complete vs incomplete revascularization in the subgroup of elderly patients> 80 years old.
Number of participants per group: Hannan E, et al. [15]​​​​​​, n=11294; Lu Y, et al. [6], n=790; Iqbal M, et al. [14], n=8436; Magalhaes M, et al. [19], n=2132; Wu C, et al. [17], n=8750. CR: complete revascularization; IR: incomplete revascularization; SE: standard error; IV: inverse variance; CI: confidence interval; df: degrees of freedom; I²: heterogeneity (I-squared); Tau²: between-study variance (Tau-squared); Chi²: Chi-squared test; Z: Z-score for overall effect; P-value: statistical significance.
Figure 7
Figure 7. Risk of myocardial infarction in complete vs incomplete revascularization in the subgroup of elderly patients > 80 years old.
Number of participants per group: Biscaglia S, et al. [5], n=1445; Hannan E, et al. [15], n=11294; Marino M, et al. [8], n=166. CR: complete revascularization; IR: incomplete revascularization; SE: standard error; IV: inverse variance; CI: confidence interval; df: degrees of freedom; I²: heterogeneity (I-squared); Tau²: between-study variance (Tau-squared); Chi²: Chi-squared test; Z: Z-score for overall effect; P-value: statistical significance.
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