Predictors of major adverse cardiac and cerebrovascular events after percutaneous coronary intervention in older adults: a systematic review and meta-analysis

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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).

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-024-04896-4.

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The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Matthew J L Page, Joanne E McKenzie, Patrick Bossuyt … (2024)

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement, published in 2009, was designed to help systematic reviewers transparently report why the review was done, what the authors did, and what they found. Over the past decade, advances in systematic review methodology and terminology have necessitated an update to the guideline. The PRISMA 2020 statement replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. The structure and presentation of the items have been modified to facilitate implementation. In this article, we present the PRISMA 2020 27-item checklist, an expanded checklist that details reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

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Assessing bias in studies of prognostic factors.

Jill Hayden, Danielle van der Windt, Jennifer L Cartwright … (2013)

Previous work has identified 6 important areas to consider when evaluating validity and bias in studies of prognostic factors: participation, attrition, prognostic factor measurement, confounding measurement and account, outcome measurement, and analysis and reporting. This article describes the Quality In Prognosis Studies tool, which includes questions related to these areas that can inform judgments of risk of bias in prognostic research.A working group comprising epidemiologists, statisticians, and clinicians developed the tool as they considered prognosis studies of low back pain. Forty-three groups reviewing studies addressing prognosis in other topic areas used the tool and provided feedback. Most reviewers (74%) reported that reaching consensus on judgments was easy. Median completion time per study was 20 minutes; interrater agreement (κ statistic) reported by 9 review teams varied from 0.56 to 0.82 (median, 0.75). Some reviewers reported challenges making judgments across prompting items, which were addressed by providing comprehensive guidance and examples. The refined Quality In Prognosis Studies tool may be useful to assess the risk of bias in studies of prognostic factors.

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Epidemiology of coronary heart disease and acute coronary syndrome.

Carme Perez-Quilis, Roman Leischik, Alejandro Lucia … (2016)

The aim of this review is to summarize the incidence, prevalence, trend in mortality, and general prognosis of coronary heart disease (CHD) and a related condition, acute coronary syndrome (ACS). Although CHD mortality has gradually declined over the last decades in western countries, this condition still causes about one-third of all deaths in people older than 35 years. This evidence, along with the fact that mortality from CHD is expected to continue increasing in developing countries, illustrates the need for implementing effective primary prevention approaches worldwide and identifying risk groups and areas for possible improvement.

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Author and article information

Contributors

Akbar Shafiee: ashafiee@tums.ac.ir

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 12 April 2024

Publication date PMC-release: 12 April 2024

Publication date Collection: 2024

Volume: 24

Electronic Location Identifier: 337

Affiliations

[1 ]GRID grid.411705.6, ISNI 0000 0001 0166 0922, Tehran Heart Center, , Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, ; North Kargar Ave, 1411713138 Tehran, Iran

[2 ]Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, ( https://ror.org/01c4pz451) Tehran, Iran

[3 ]Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, ( https://ror.org/01c4pz451) Tehran, Iran

[4 ]Research Center for Advanced Technologies in Cardiovascular Medicine, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, ( https://ror.org/01c4pz451) Tehran, Iran

[5 ]Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, ( https://ror.org/01c4pz451) Tehran, Iran

Author information

Arash Jalali http://orcid.org/0000-0003-3225-8498

Ali Hassanzadeh http://orcid.org/0000-0002-0734-3888

Mohammad Sadeq Najafi http://orcid.org/0000-0002-5041-6798

Sepehr Nayebirad http://orcid.org/0000-0002-5914-9227

Mohadese Dashtkoohi http://orcid.org/0000-0003-3579-4181

Zahra Karimi http://orcid.org/0000-0001-6912-7788

Article

Publisher ID: 4896

DOI: 10.1186/s12877-024-04896-4

PMC ID: 11015672

PubMed ID: 38609875

SO-VID: c2eba02d-a813-4a7e-b6f8-dd8164e0d599

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 1 July 2023

Date accepted : 15 March 2024

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ScienceOpen disciplines: Geriatric medicine

Keywords: percutaneous coronary intervention,older adults,coronary artery disease,major adverse cardiac events

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ScienceOpen disciplines: Geriatric medicine

Keywords: percutaneous coronary intervention, older adults, coronary artery disease, major adverse cardiac events

Predictors of major adverse cardiac and cerebrovascular events after percutaneous coronary intervention in older adults: a systematic review and meta-analysis

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Abstract

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Registration

Supplementary Information

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Cardiovascular Innovations and Applications

Most cited references 81

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

Assessing bias in studies of prognostic factors.

Epidemiology of coronary heart disease and acute coronary syndrome.

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