Key result
An early invasive strategy did not significantly reduce the risk of major adverse cardiac and cerebrovascular events compared to a delayed invasive strategy in older adults with NSTEMI receiving new-generation drug-eluting stents (aHR 1.198).
Why the study?
To evaluate 3-year clinical outcomes between early and delayed invasive strategies in older adults with NSTEMI undergoing successful new-generation DES implantation to reflect real-world practice.
Does an early invasive strategy reduce major adverse cardiac and cerebrovascular events in older adults with NSTEMI receiving new-generation drug-eluting stents compared to a delayed invasive strategy?
Observational (n=4,513)
Yes
Does an early invasive strategy reduce major adverse cardiac and cerebrovascular events in older adults with NSTEMI receiving new-generation drug-eluting stents compared to a delayed invasive strategy?
Hazard Ratio: 1.198 (95% CI 0.944–1.521)
Absolute Event Rate: 16.4% vs 15.1%
p-value: p=0.137
In older adults with NSTEMI undergoing successful new-generation DES implantation, an early invasive strategy did not significantly improve 3-year clinical outcomes compared to a delayed invasive strategy.
Similar 3-year outcomes with EI versus DI strategies in older NSTEMI patients; leaves open optimal timing and supports individualized decisions pending randomized 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, 4513 patients with NSTEMI were recruited from Korea Acute Myocardial Infarction Registry-National Institute of Health. They were divided into two groups according to their ages: group A (age ≥65 years, n = 2,253) and group B (age <65 years, n = 2,260). These two groups of patients were further divided into two subgroups: group EI (A1 or B1) and DI (A2 or B2). The primary clinical outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs), defined by all-cause death, recurrent MI (re-MI), and any repeat coronary revascularization. The secondary clinical outcome was stent thrombosis (ST). In both, group A and B, after multivariable-adjusted and propensity score-adjusted 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=4,513). Early invasive strategy vs. Delayed invasive strategy was evaluated on Major adverse cardiac and cerebrovascular events (MACCE) in older adults (Group A, ≥65 years) (aHR 1.198, 95% CI 0.944-1.521, p=0.137). An early invasive strategy did not significantly reduce the risk of major adverse cardiac and cerebrovascular events compared to a delayed invasive strategy in older adults with NSTEMI receiving new-generation drug-eluting stents (aHR 1.198).
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