Recommended Citation
Khalil M, Maqsood MH, Basir M, Saad M, Yassa G, Hakam L, Hennawy B, El Etriby S, Garcia S, Brilakis E, Alaswad K, and Megaly M. Invasive Versus Conservative Strategy in Elderly Patients With Non–ST-Segment Elevation Myocardial Infarction: A Meta-analysis of Randomized Controlled Trials. J Am Coll Cardiol 2022; 80(12):B3.
Document Type
Conference Proceeding
Publication Date
9-1-2022
Publication Title
J Am Coll Cardiol
Abstract
Background: Management of non–ST-segment elevation myocardial infarction (NSTEMI) has evolved over the years, but most published data are from younger patients. Data on the NSTEMI management in elderly patients remains limited. Methods: We performed a meta-analysis of randomized controlled trials (RCTs) to evaluate the long-term outcomes of invasive vs conservative strategies in elderly patients with NSTEMI.
Results: Of 1,550 reports searched, 4 RCTs (1,126 patients) were included in the analysis with a median follow-up of 1.25 years (range: 1 to 2.5 years). The median age of included patients was 83.6 (IQR 2.8 years). The invasive strategy was associated with significantly lower risk of major adverse cardiac and cerebrovascular event (MACCE) [OR 0.60 (95% CI 0.40-0.91); I2 =54%; 3 trials] and unplanned revascularization [OR 0.31 (95% CI 0.15-0.64); I2 = 1.7%; 3 trials] compared with the conservative strategy. There was no difference in all-cause mortality [OR= 0.88 (95% CI 0.65-1.18); I2 = 0%; 4 trials], myocardial infarction (MI) [OR= 0.70 (95% CI 0.42-1.19); I2 = 54.7%; 4 trials], or bleeding [OR= 0.87 (95% C: 0.39-1.93); I2 = 0%; 3 trials] between both strategies.
Conclusion: The use of initial invasive strategy in elderly patients presenting with NSTEMI was associated with a significantly lower risk of MACCE and unplanned revascularization compared with the initial conservative strategy without increased bleeding.
Categories: CORONARY: Acute Coronary Syndromes
Volume
80
Issue
12
First Page
B3
