Skip to main content
SpringerLink
Log in

Clinical impact of non-culprit lesions on 1-year mortality in very elderly patients with acute coronary syndrome

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Preventive percutaneous coronary intervention (PCI) for non-culprit lesions after primary PCI remains controversial in patients with acute coronary syndrome (ACS). We analyzed whether PCI for non-culprit lesions would be associated with a better long-term prognosis in very elderly (≥85 years) patients. This study included 91 consecutive patients with ACS (mean age, 88.2 ± 3.0, 52 % male). We investigated the association of residual lesions with 1-year mortality. Culprit lesions affected the left anterior descending artery (LAD) in 50 patients, the left circumflex artery (LCx) in 29, and the right coronary artery (RCA) in 31. Residual lesions affected LAD in 20 cases, LCx in 22, and RCA in 21 patients. Residual lesions in LAD were associated with a higher 1-year mortality (p = 0.013), whereas residual lesions in LCx or RCA were not (p = 0.547 and 0.473, respectively). A Cox regression model demonstrated that patients with residual lesions in LAD had an increased risk of 1-year mortality compared with those without residual lesions (hazard ratio, 2.39; 95 % confidence interval, 1.16–4.96; p = 0.019). Therefore, the option to not treat residual lesions in LAD of patients with PCI may be associated with a higher 1-year mortality. Further studies are needed to confirm these findings.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Naito R, Miyauchi K, Konishi H, Tsuboi S, Ogita M, Dohi T, Kajimoto K, Kasai T, Tamura H, Okazaki S, Isoda K, Yamamoto T, Amano A, Daida H (2015) Comparing mortality between coronary artery bypass grafting and percutaneous coronary intervention with drug-eluting stents in elderly with diabetes and multivessel coronary disease. Heart Vessels. doi:10.1007/s00380-015-0746-1

    PubMed Central  Google Scholar 

  2. Cavender MA, Milford-Beland S, Roe MT, Peterson ED, Weintraub WS, Rao SV (2009) Prevalence, predictors, and in-hospital outcomes of non-infarct artery intervention during primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (from the National Cardiovascular Data Registry). Am J Cardiol 104:507–513

    Article  PubMed  Google Scholar 

  3. Vlaar PJ, Mahmoud KD, Holmes DR Jr, van Valkenhoef G, Hillege HL, van der Horst IC, Zijlstra F, de Smet BJ (2011) Culprit vessel only versus multivessel and staged percutaneous coronary intervention for multivessel disease in patients presenting with ST-segment elevation myocardial infarction: a pairwise and network meta-analysis. J Am Coll Cardiol 58:692–703

    Article  PubMed  Google Scholar 

  4. Abe D, Sato A, Hoshi T, Takeyasu N, Misaki M, Hayashi M, Aonuma K (2014) Initial culprit-only versus initial multivessel percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction: results from the Ibaraki Cardiovascular Assessment Study registry. Heart Vessels 29:171–177

    Article  PubMed  Google Scholar 

  5. Kowalewski M, Schulze V, Berti S, Waksman R, Kubica J, Kolodziejczak M, Buffon A, Suryapranata H, Gurbel PA, Kelm M, Pawliszak W, Anisimowicz L, Navarese EP (2015) Complete revascularisation in ST-elevation myocardial infarction and multivessel disease: meta-analysis of randomised controlled trials. Heart 101:1309–1317

    Article  CAS  PubMed  Google Scholar 

  6. Wald DS, Morris JK, Wald NJ, Chase AJ, Edwards RJ, Hughes LO, Berry C, Oldroyd KG (2013) Randomized trial of preventive angioplasty in myocardial infarction. N Engl J Med 369:1115–1123

    Article  CAS  PubMed  Google Scholar 

  7. Killip T 3rd, Kimball JT (1967) Treatment of myocardial infarction in a coronary care unit. A 2-year experience with 250 patients. Am J Cardiol 20:457–464

    Article  PubMed  Google Scholar 

  8. Politi L, Sgura F, Rossi R, Monopoli D, Guerri E, Leuzzi C, Bursi F, Sangiorgi GM, Modena MG (2010) A randomised trial of target-vessel versus multi-vessel revascularisation in ST-elevation myocardial infarction: major adverse cardiac events during long-term follow-up. Heart 96:662–667

    Article  PubMed  Google Scholar 

  9. Higuchi S, Kabeya Y, Matsushita K, Taguchi H, Ishiguro H, Kohshoh H, Yoshino H (2016) Barthel index as a predictor of 1-year mortality in very elderly patients who underwent percutaneous coronary intervention for acute coronary syndrome: better activities of daily living, longer life. Clin Cardiol 39:83–89

    Article  PubMed  Google Scholar 

  10. Boden WE, O’Rourke RA, Teo KK, Hartigan PM, Maron DJ, Kostuk WJ, Knudtson M, Dada M, Casperson P, Harris CL, Chaitman BR, Shaw L, Gosselin G, Nawaz S, Title LM, Gau G, Blaustein AS, Booth DC, Bates ER, Spertus JA, Berman DS, Mancini GB, Weintraub WS (2007) Optimal medical therapy with or without PCI for stable coronary disease. N Engl J Med 356:1503–1516

    Article  CAS  PubMed  Google Scholar 

  11. Shaw LJ, Berman DS, Maron DJ, Mancini GB, Hayes SW, Hartigan PM, Weintraub WS, O’Rourke RA, Dada M, Spertus JA, Chaitman BR, Friedman J, Slomka P, Heller GV, Germano G, Gosselin G, Berger P, Kostuk WJ, Schwartz RG, Knudtson M, Veledar E, Bates ER, McCallister B, Teo KK, Boden WE (2008) Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 117:1283–1291

    Article  PubMed  Google Scholar 

  12. Hachamovitch R, Hayes SW, Friedman JD, Cohen I, Berman DS (2003) Comparison of the short-term survival benefit associated with revascularization compared with medical therapy in patients with no prior coronary artery disease undergoing stress myocardial perfusion single photon emission computed tomography. Circulation 107:2900–2907

    Article  PubMed  Google Scholar 

  13. O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Stevenson WG, Yancy CW (2013) 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 127:e362–e425

    Article  PubMed  Google Scholar 

  14. Bainey KR, Mehta SR, Lai T, Welsh RC (2014) Complete vs culprit-only revascularization for patients with multivessel disease undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a systematic review and meta-analysis. Am Heart J 167(1–14):e12

    Google Scholar 

  15. Bauer T, Zeymer U, Hochadel M, Mollmann H, Weidinger F, Zahn R, Nef HM, Hamm CW, Marco J, Gitt AK (2013) Prima-vista multi-vessel percutaneous coronary intervention in haemodynamically stable patients with acute coronary syndromes: analysis of over 4.400 patients in the EHS-PCI registry. Int J Cardiol 166:596–600

    Article  PubMed  Google Scholar 

  16. Zeymer U, Hochadel M, Thiele H, Andresen D, Schuhlen H, Brachmann J, Elsasser A, Gitt A, Zahn R (2015) Immediate multivessel percutaneous coronary intervention versus culprit lesion intervention in patients with acute myocardial infarction complicated by cardiogenic shock: results of the ALKK-PCI registry. EuroIntervention 11:280–285

    Article  PubMed  Google Scholar 

  17. Hassanin A, Brener SJ, Lansky AJ, Xu K, Stone GW (2015) Prognostic impact of multivessel versus culprit vessel only percutaneous intervention for patients with multivessel coronary artery disease presenting with acute coronary syndrome. EuroIntervention 11:293–300

    Article  PubMed  Google Scholar 

  18. Sarathy K, Nagaraja V, Kapur A, Szirt R, Raval J, Eslick GD, Burgess D, Denniss AR (2015) Target-vessel versus multivessel revascularisation in ST-elevation myocardial infarction: a meta-analysis of randomised trials. Heart Lung Circ 24:327–334

    Article  PubMed  Google Scholar 

  19. Jensen LO, Thayssen P, Farkas DK, Hougaard M, Terkelsen CJ, Tilsted HH, Maeng M, Junker A, Lassen JF, Horvath-Puho E, Sorensen HT, Thuesen L (2012) Culprit only or multivessel percutaneous coronary interventions in patients with ST-segment elevation myocardial infarction and multivessel disease. EuroIntervention 8:456–464

    Article  PubMed  Google Scholar 

  20. Kornowski R, Mehran R, Dangas G, Nikolsky E, Assali A, Claessen BE, Gersh BJ, Wong SC, Witzenbichler B, Guagliumi G, Dudek D, Fahy M, Lansky AJ, Stone GW (2011) Prognostic impact of staged versus “one-time” multivessel percutaneous intervention in acute myocardial infarction: analysis from the HORIZONS-AMI (harmonizing outcomes with revascularization and stents in acute myocardial infarction) trial. J Am Coll Cardiol 58:704–711

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine II, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan

    Satoshi Higuchi, Kenichi Matsushita, Hiroki Taguchi, Haruhisa Ishiguro, Hideyasu Kohshoh & Hideaki Yoshino

  2. Division of General Internal Medicine, Department of Internal Medicine, Tokai University Hachioji Hospital, 1838 Ishikawamachi, Hachioji, Japan

    Yusuke Kabeya

Authors
  1. Satoshi Higuchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yusuke Kabeya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kenichi Matsushita
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroki Taguchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Haruhisa Ishiguro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hideyasu Kohshoh
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hideaki Yoshino
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideaki Yoshino.

Ethics declarations

Conflict of interest

The authors have no conflict of interests to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Higuchi, S., Kabeya, Y., Matsushita, K. et al. Clinical impact of non-culprit lesions on 1-year mortality in very elderly patients with acute coronary syndrome. Heart Vessels 32, 8–15 (2017). https://doi.org/10.1007/s00380-016-0833-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-016-0833-y

Keywords

Search

Navigation