Key result
Invasive strategy cuts death or MI ~33% vs conservative care in older NSTE-ACS patients.
Why the study?
Does an invasive strategy reduce the composite of death or MI in older adults ≥75 years with NSTE-ACS compared to a conservative strategy?
Meta-Analysis (n=2,429)
Does an invasive strategy reduce the composite of death or MI in older adults ≥75 years with NSTE-ACS compared to a conservative strategy?
In older adults ≥75 years with NSTE-ACS, an invasive strategy significantly reduces the composite risk of death and MI compared to a conservative strategy without significantly increasing major bleeding.
Answers are grounded in this paper and cite their sources.
Supports invasive strategy in ≥75-year-olds with NSTE-ACS; extends RCT evidence to this age group.
Background Older adults with non–ST‐segment–elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions. Methods and Results We searched for randomized controlled trials comparing invasive versus medical management or a selective invasive (conservative) strategy for older patients (age≥75 years) with non–ST‐segment–elevation acute coronary syndrome. Fixed effects meta‐analysis was conducted to estimate the odds ratio (OR) with 95% CI for the composite of death or myocardial infarction (MI) and individual secondary end points of all‐cause death, cardiovascular death, MI, revascularization, stroke, and major bleeding. Nine studies with 2429 patients (invasive: 1228 versus control: 1201) with a mean follow‐up of 21 months were included. An invasive strategy was associated with a significantly decreased risk of a composite of death and MI (OR, 0.67 [95% CI, 0.54–0.83], P <0.001), MI (OR, 0.56 [95% CI, 0.45–0.70], P <0.001) and subsequent revascularization (OR, 0.27 [95% CI, 0.16–0.48], P <0.001). There was no difference in all‐cause death (OR, 0.84 [95% CI, 0.65–1.10], P =0.21), cardiovascular death (OR, 0.85 [95% CI, 0.63–1.15], P =0.30), stroke (OR, 0.74 [95% CI, 0.38–1.47], P =0.39), or major bleeding (OR, 1.24 [95% CI, 0.42–3.66], P =0.70). Conclusions In older patients ≥75 years old with non–ST‐segment–elevation acute coronary syndrome, an invasive strategy reduced the risk of a composite of death and MI, MI, and subsequent revascularization compared with a conservative strategy alone. Older adults with higher burden of geriatric conditions should be included in future trials to improve generalizability to this growing population.
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Rout et al. (2024) conducted a meta-analysis in Non-ST-segment-elevation acute coronary syndrome (n=2,429). Invasive strategy vs. Medical management or a selective invasive (conservative) strategy was evaluated on Composite of death or myocardial infarction (MI) (OR 0.67, 95% CI 0.54-0.83, p=<0.001). In older adults ≥75 years with NSTE-ACS, an invasive strategy reduced the composite risk of death or MI compared with a conservative strategy.
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