Key result
Early invasive strategy shows no benefit over delayed approach for MACCE in older NSTEMI patients.
Why the study?
To evaluate 3-year clinical outcomes of early versus delayed invasive strategies in older adults with NSTEMI undergoing successful new-generation DES implantation in real-world practice.
Does an early invasive strategy reduce major adverse cardiac and cerebrovascular events in older adults with NSTEMI undergoing successful new-generation DES implantation compared to a delayed invasive strategy?
Observational (n=2,437)
Yes
Does an early invasive strategy reduce major adverse cardiac and cerebrovascular events in older adults with NSTEMI undergoing successful new-generation DES implantation compared to a delayed invasive strategy?
Effect estimate: aHR 1.159 (95% CI 0.960-1.398)
Absolute Event Rate: 24.5% vs 22.6%
p-value: p=0.125
Early invasive strategy offers no MACCE reduction versus delayed in older NSTEMI; challenges routine early intervention and supports timing optimization trials.
We evaluated the 3-year clinical outcomes following early invasive (EI) and delayed invasive (DI) strategies in older adults with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing successful new-generation drug-eluting stents (DESs) implantation to reflect current real-world practice. Overall, 2437 older adults (age, ≥ 65 years) with NSTEMI were recruited from the Korea Acute Myocardial Infarction Registry-National Institute of Health. They were divided into two groups: EI (n = 1750) and DI (n = 687). The primary clinical outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs), defined by all-cause death, recurrent MI, any repeat coronary revascularization, and stroke. The secondary clinical outcome was stent thrombosis (ST). After multivariable-adjusted and propensity score-matched analyses, the primary and secondary clinical outcomes were not significantly different between the EI and DI groups. Even after the analysis was confined to those having complex lesions, these major clinical outcomes were similar between these two groups. The EI and DI strategies in older adults with NSTEMI receiving new-generation DES showed comparable results.Clinical Trial Registration: URL: http://cris.nih.go.kr/cris/en/ ; Unique identifier: KCT0000863.
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Kim et al. (2022) conducted an observational in Non-ST-segment elevation myocardial infarction (NSTEMI) (n=2,437). Early invasive strategy vs. Delayed invasive strategy was evaluated on Major adverse cardiac and cerebrovascular events (MACCEs) (aHR 1.159, 95% CI 0.960-1.398, p=0.125). An early invasive strategy did not significantly reduce the 3-year risk of major adverse cardiac and cerebrovascular events compared to a delayed invasive strategy in older adults with NSTEMI (aHR 1.159).
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