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Several studies have shown the superiority of complete revascularization strategy in acute coronary syndrome (ACS) patients. However, it remains uncertain whether it is also evident in octogenarian ACS patients.
This study was an observational study examining consecutive ACS patients from January 2009 to December 2014. Study population included 2025 ACS cases. Of them, 467 patients were octogenarian. The residual Syntax score(rSS) was calculated at the time of post primary or primarily scheduled PCI angiography. Patients were dichotomized into low (<8) and high rSS (≥8) groups and outcomes were compared between groups. The primary outcome of net adverse cardiovascular events (NACE) consisted of a composite of all-cause mortality, non-fatal MI, and any revascularization at 1 year. To investigate the significance of staged PCI in octogenarian patients to reduce rSS, the comparison between high and low rSS with or without staged PCI was also performed.
The median rSS was 4 (0-9). The incidence of NACE at 1 year was significantly higher in high rSS group than low rSS group (45.5% versus 23.6%, p<.0001). The incidence of all-cause death (28.0% versus 12.9%, p=.0001) and any revascularization (17.6% versus 11.5%, p=.0094) were also higher in high rSS group. On the other hands, there was no significantly difference between two groups in non-fatal MI (0% versus 0.7%, p=.34). After adjustment for confounders, a high rSS was also an independent predictor of the primary outcome with a hazard ratio of 2.50 (95% confidential interval [CI], 1.61-3.88; p<.0001). Furthermore, low rSS groups with or without staged PCI had better primary outcome compared to high rSS (low rSS with staged PCI 29.8%, low rSS without staged PCI 23.9% versus high rSS with staged PCI 66.7%, high rSS without staged PCI 48.3%, p<.0001).
Our study suggests that it has clinical importance even for octogenarian ACS patients to perform staged PCI and lower rSS.
CORONARY: Acute Coronary Syndromes