Long-term outcomes and predictors of morbi-mortality according to age in stemi patients with multivessel disease: Impact of an incomplete revascularization.
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.
['Rumiz|Eva|E|0000-0001-6860-0801', 'Berenguer|Alberto|A|', 'Vilar|Juan Vicente|JV|', 'Valero|Ernesto|E|', 'Facila|Lorenzo|L|', 'Cubillos|Andres|A|', 'Sanmiguel|Dario|D|', 'Almela|Pablo|P|', 'Morell|Salvador|S|']
D000368:Aged D000369:Aged, 80 and over D017023:Coronary Angiography D003324:Coronary Artery Disease D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D062645:Percutaneous Coronary Intervention D011446:Prospective Studies D018570:Risk Assessment D012307:Risk Factors D000072657:ST Elevation Myocardial Infarction D016896:Treatment Outcome
multivessel disease ST-segment elevation myocardial infarction elderly primary percutaneous coronary intervention