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Predictors of Major Adverse Cardiac and Cerebrovascular Events After Percutaneous Coronary Intervention in Older Adults: A Systematic Review and Meta-Analysis Publisher Pubmed



Jalali A1, 2 ; Hassanzadeh A3 ; Najafi MS4 ; Nayebirad S1 ; Dashtkoohi M5 ; Karimi Z1, 2 ; Shafiee A1
Authors
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Authors Affiliations
  1. 1. Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Ave, Tehran, 1411713138, Iran
  2. 2. Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  3. 3. Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  4. 4. Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
  5. 5. Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran

Source: BMC Geriatrics Published:2024


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). © The Author(s) 2024.
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