Key result
Invasive treatment was associated with a lower risk of long-term mortality compared to conservative management in NSTE-ACS patients aged ≥80 years (HR 0.70; 95% CI 0.54-0.92; P=0.010).
Why the study?
Invasive treatment is commonly recommended for NSTE-ACS, but its efficacy in patients aged 80 years or older remains uncertain.
Does an invasive treatment strategy reduce all-cause mortality in patients aged 80 years or older with NSTE-ACS?
Cohort (n=1,201)
No
Does an invasive treatment strategy reduce all-cause mortality in patients aged 80 years or older with NSTE-ACS?
Hazard Ratio: 0.7 (95% CI 0.54–0.92)
p-value: p=0.010
In patients aged 80 years or older with NSTE-ACS, an invasive treatment strategy is associated with a significantly lower risk of long-term all-cause mortality compared to conservative management.
Invasive strategy was associated with lower mortality; supports randomized trials before changing practice in octogenarians with NSTE-ACS.
Background: Invasive treatment is commonly recommended for patients with non-ST-elevation acute coronary syndromes (NSTE-ACS). However, the efficacy of this approach in patients aged ≥80 years remains uncertain. Methods: We retrospectively assessed consecutive NSTE-ACS patients ≥80 years of age who were hospitalized at our cardiovascular center from December 2012 to July 2019. Patients were divided into two groups based on whether they received invasive treatment (coronary angiography and, if indicated, revascularization) or not. Patients who died in the first 3 days after admission without receiving invasive treatment were excluded. The effect of invasive timed treatment was also explored by dividing patients into timely invasive or delayed invasive groups according to their risk classification. Multivariate COX regression, invasive probability weighting and propensity score matching were used to adjust for confounding variables. The primary outcome was all-cause death during follow-up. Results: A total of 1,201 patients with a median age of 82.0 (IQR, 81.0-84.0) were divided into two groups: 656 (54.6%) patients in the invasive group and 545 (45.4%) patients in the conservative group. Follow-up survival information was available for up to 6 years (median 3.0 years). During the follow-up, 296 (24.6%) patients died. After adjusting for confounding variables, the invasive treatment strategy was significantly associated with a lower risk of long-term mortality (HR =0.70, 95% CI: 0.54-0.92, P=0.010). No difference was found between timely invasive and delayed invasive interventions with mortality (HR =0.92, 95% CI: 0.57-1.47, P=0.725). Conclusions: Invasive treatment was associated with lower mortality in patients ≥80 years of age with NSTE-ACS over a median of a 3-year follow-up. The invasive intervention time did not impact the outcome.
No takes yet. Share an insight, caveat, or question.
Zhang et al. (2022) conducted a cohort in non-ST-elevation acute coronary syndromes (NSTE-ACS) (n=1,201). Invasive treatment (coronary angiography and revascularization) vs. Conservative treatment was evaluated on All-cause death during follow-up (HR 0.70, 95% CI 0.54-0.92, p=0.010). Invasive treatment was associated with a lower risk of long-term mortality compared to conservative management in NSTE-ACS patients aged ≥80 years (HR 0.70; 95% CI 0.54-0.92; P=0.010).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: