Document Type

Conference Proceeding

Publication Date


Publication Title

J Am Coll Cardiol


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





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