title: Clinical impact of complete revascularization in elderly patients with multi-vessel coronary artery disease undergoing percutaneous coronary intervention: A sub-analysis of the SHINANO registry.
abstract: BACKGROUND
  Prior reports have revealed that complete revascularization (CR) by percutaneous coronary intervention (PCI) decreased ischemic events. However, little is known about the efficacy of CR using PCI in elderly patients with multi-vessel coronary artery disease (CAD). We evaluated the 1-year effectiveness of CR-PCI in elderly patients (≥75years old) with multi-vessel CAD.
  
  
  METHODS
  The SHINANO Registry, a prospective, observational, multi-center, all-comer cohort study, has enrolled 1923 patients. From this registry, we recruited 322 elderly patients with multi-vessel CAD. The primary endpoint was major adverse cardiovascular events ([MACE]: all-cause mortality, myocardial infarction, and stroke).
  
  
  RESULTS
  Of the 322 elderly patients with multi-vessel CAD, 165 (51.2%) received CR and 157 (48.8%) received incomplete revascularization (ICR). MACE occurred in 44 (13.7%) patients. The incidence of MACE by survival analysis was significantly lower in the CR group than in the ICR group (7.4% vs. 21.1%, p<0.001). On multivariable Cox proportional hazards analysis of age, sex, and acute coronary syndrome (ACS), ACS and CR were independent predictors of MACE (hazard ratio [HR], 2.49; 95% confidence interval [CI], 1.29-4.80; p=0.007, HR, 0.40; 95% CI, 0.20-0.77; p=0.007, respectively). In propensity score matching of age, sex, previous heart failure, previous intracranial bleeding, ACS, and body mass index, the MACE rate was significantly lower in the CR group than in the ICR group (7.2% vs. 18.4%, p=0.015).
  
  
  CONCLUSIONS
  Even in elderly patients over 75years old with multi-vessel CAD, CR-PCI appears to suppress mid-term ischemic events.
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Nagano Prefectural Suzaka Hospital, Nagano, Japan. Electronic address: m02039mk@jichi.ac.jp.
authors.forename: Mikiko
authors.initials: M
authors.lastname: Harada
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Miura
authors.affiliation: Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Kobayashi
authors.affiliation: Department of Arrhythmology, Takatsuki General Hospital, Osaka, Japan.
authors.forename: Masanori
authors.initials: M
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, Nagano Matsushiro General Hospital, Nagano, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakajima
authors.affiliation: Department of Cardiology, Saku Medical Center, Nagano, Japan.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Kimura
authors.affiliation: Department of Cardiology, Iida Municipal Hospital, Nagano, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Akanuma
authors.affiliation: Department of Cardiology, North Alps Medical Center Azumi Hospital, Nagano, Japan.
authors.forename: Eiichiro
authors.initials: E
authors.lastname: Mawatari
authors.affiliation: Department of Cardiology, Okaya City Hospital, Nagano, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Sato
authors.affiliation: Hotta Medical Clinic, Nagano, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Hotta
authors.affiliation: Department of Cardiology, Aizawa Hospital, Nagano, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Kamiyoshi
authors.affiliation: Department of Cardiology, Shinonoi General Hospital, Nagano, Japan.
authors.forename: Takuya
authors.initials: T
authors.lastname: Maruyama
authors.affiliation: Department of Cardiology, Hokushin General Hospital, Nagano, Japan.
authors.forename: Noboru
authors.initials: N
authors.lastname: Watanabe
authors.affiliation: Department of Cardiology, Komoro Kosei General Hospital, Japan.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Eisawa
authors.affiliation: Department of Cardiology, Shinonoi General Hospital, Nagano, Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Hashizume
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ebisawa
authors.affiliation: Department of Cardiovascular Medicine, Nagano Red Cross Hospital, Nagano, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Miyashita
authors.affiliation: Department of Cardiovascular Medicine, Shinshu University School of Medicine, Nagano, Japan; Department of Cardiology, Nagano Municipal Hospital, Nagano, Japan.
authors.forename: Uichi
authors.initials: U
authors.lastname: Ikeda
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D062645:Percutaneous Coronary Intervention; D012042:Registries; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Complete revascularization; Elderly; Major adverse cardiovascular events; Multi-vessel coronary artery disease; Percutaneous coronary intervention