What question did this study set out to answer?

This analysis evaluates whether invasive or conservative treatment strategies are more effective and safe for older patients with NSTEMI.

February 6, 2026

Invasive vs. conservative strategies in older patients with non-st-segment elevation myocardial infarction: an updated systematic review and meta-analysis

Key Points

This analysis evaluates whether invasive or conservative treatment strategies are more effective and safe for older patients with NSTEMI.
Conducted a systematic review and meta-analysis of randomized controlled trials (RCTs).
Searched PubMed, Embase, and the Cochrane Central Register for relevant studies.
Compared outcomes between invasive and conservative treatment strategies in patients aged 75 and older.
Invasive strategy significantly reduced the risk of recurrent myocardial infarction (OR 0.65).
Invasive strategy reduced revascularization needs (OR 0.31) but increased major bleeding risk (OR 1.79).
No significant differences were found in all-cause mortality, cardiovascular death, or stroke between groups.

Abstract

Abstract Background Non-ST-segment elevation myocardial infarction (NSTEMI) is a prevalent condition among older adults, yet the optimal management strategy remains uncertain. While invasive treatment approaches, including coronary angiography and revascularization, are recommended in younger populations, their benefits in older patients with increased frailty and comorbidities are debated. Purpose This systematic review and meta-analysis aimed to evaluate the efficacy and safety of invasive versus conservative treatment strategies in older patients (≥75 years) with NSTEMI. Methods We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials (RCTs) that compared invasive and conservative strategies in older NSTEMI patients. The primary outcome was a composite of cardiovascular death and nonfatal myocardial infarction. Secondary outcomes included all-cause mortality, stroke, recurrent myocardial infarction, and major bleeding. A random-effects model was used for meta-analysis, Statistical analysis was carried out utilizing R version 4.4.2. Heterogeneity was assessed with I² statistics; p-values inferior to 0.05 and I²25% were considered significant heterogeneity. Results This meta-analysis included 11 RCTs with 6,932 patients. The invasive strategy reduced the risk of recurrent myocardial infarction (OR 0.65; 95% CI: 0.56–0.75; p0.01; I²=25%) and revascularization (OR 0.31; 95% CI: 0.23–0.42; p0.001; I²=0%), but increased the risk of major bleeding (OR 1.79; 95% CI: 1.17–2.73; p0.01; I²=0%). No significant differences were observed between strategies for all-cause mortality (OR 0.99; 95% CI: 0.77–1.27; p=0.92; I²=24%), cardiovascular death (OR 1.14; 95% CI: 0.96–1.36; p=0.129; I²=0%), stroke recurrence (OR 0.96; 95% CI: 0.69–1.35; p=0.83; I²=0%), or hospitalization (OR 1.03; 95% CI: 0.62–1.74; p=0.89; I²=65.6%). Conclusions This systematic review and meta-analysis suggest that the invasive strategy reduced recurrent MI and revascularization but increased major bleeding, with no impact on mortality, stroke, or hospitalization. Treatment decisions should balance ischemic benefits and bleeding risks.

AI से पूछें

Bookmark

Cite This Study

Lucena et al. (Sat,) studied this question.

synapsesocial.com/papers/698585678f7c464f23008bb2 https://doi.org/https://doi.org/10.1093/eurheartj/ehaf784.1766

AI से पूछें

Bookmark