A routine invasive approach in elderly patients with UA/NSTEMI did not significantly reduce all-cause mortality (log RR 0.142) but significantly reduced the incidence of MI (log RR 0.519).
Meta-Analysis (n=3,016)
Does a routine invasive approach reduce the composite of all-cause death and MI in elderly patients with UA/NSTEMI compared to a conservative approach?
In elderly patients with UA/NSTEMI, a routine invasive strategy reduces the incidence of MI but does not significantly reduce all-cause mortality compared to a conservative approach.
Effect estimate: log RR 0.142 (mortality), log RR 0.519 (MI) (95% CI 0.363-0.78 (mortality), 0.707-0.331 (MI))
Background and Aim: Compared with their younger counterparts, the elderly with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTMI) has been proven to have worse outcomes. People with UA/NSTEMI are managed with a combination of medical therapy, invasive angiography, and revascularization. A systematic review and meta-analysis was conducted to compare the effects and the benefits associated with the routine invasive approach versus a conservative or “selective invasive” approach for the management of UA/NSTEMI in the elderly. Methods: Data from randomized controlled trials (RCTs) were identified through search strategy filters. Five search engines and databases were searched systematically, namely PubMed, CINAHL, ScienceDirect, Web of Science, and Cochrane Library. The primary outcome of the analysis was the composite of all-cause death and myocardial infarction (MI). Results: Four RCTs with total of 3016 patients were eligible. We calculated the log risk ratio with 95% confidence intervals (CIs) for the primary endpoints of all-cause death and MI. The study analysis did not show appreciable risk reductions in all-cause mortality (log risk ratio: 0.142 and 95% CI = 0.363–0.78, 4 studies, 3016 participants, and low-quality evidence). However, it shows that there was a significant risk reduction in the incidence of MI (log risk ratio 0.519, 95% CI = 0.707–0.331, 4 studies, 3016 participants, and low quality of evidence). Conclusion: A routine invasive approach in the elderly with UA/NSTMI was not associated with any significance in terms of mortality compared with conservative approach. However, research suggests that the invasive strategy may have particular benefit in the elderly who are at high risk for recurrent events and that patients at low risk for a recurrent event may even suffer harm from such strategy approach.
Tashani et al. (Tue,) conducted a meta-analysis in Unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI) (n=3,016). Routine invasive approach vs. Conservative or selective invasive approach was evaluated on Composite of all-cause death and myocardial infarction (MI) (log RR 0.142 (mortality), log RR 0.519 (MI), 95% CI 0.363-0.78 (mortality), 0.707-0.331 (MI)). A routine invasive approach in elderly patients with UA/NSTEMI did not significantly reduce all-cause mortality (log RR 0.142) but significantly reduced the incidence of MI (log RR 0.519).
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