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October 17, 2007European Heart JournalOpen Access

Effect of an invasive strategy on in-hospital outcome in elderly patients with non-ST-elevation myocardial infarction

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Key result

An invasive strategy in elderly patients with NSTEMI was associated with significantly lower in-hospital mortality compared to conservative treatment (adjusted OR 0.55; 95% CI 0.35-0.86).

Why the study?

Does an invasive strategy reduce mortality and myocardial infarction in elderly patients (≥75 years) with NSTEMI compared to conservative treatment?

Population

1,936 elderly patients with non-ST elevation myocardial infarction prospectively enrolled in the German…

Comparison

Invasive strategy vs Conservative treatment

Design

Cohort

Follow-up

in-hospital and 1 year

Authors

TBTimm BauerOKOliver KoethCJClaus Jünger

Discussion

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Overview

May support invasive strategy in elderly NSTEMI; leaves open randomized confirmation of mortality benefit.

Key Points

  • To determine the impact of an invasive treatment strategy on in-hospital and one-year clinical outcomes in elderly patients presenting with non-ST-elevation myocardial infarction in everyday clinical practice.
  • Analyzed prospective registry data from N=1,936 consecutive elderly patients (≥75 years) with NSTEMI enrolled in the German Acute Coronary Syndromes registry between July 2000 and November 2002.
  • Compared outcomes between patients managed with an invasive approach (coronary angiography and/or revascularization, n=1,005 [51.9%]) and those managed conservatively (n=931 [48.1%]).
  • Applied propensity score analysis to adjust for baseline confounding factors across in-hospital and 1-year clinical endpoints.
  • In-hospital mortality was significantly lower in the invasive strategy group compared to the conservative group (6.0% vs. 12.5%, P < 0.0001), as was the composite of death or myocardial infarction (9.6% vs. 17.3%, P < 0.0001).
  • After propensity score adjustment, the invasive strategy was associated with significantly reduced in-hospital mortality (OR 0.55, 95% CI 0.35–0.86), death/non-fatal MI (OR 0.51, 95% CI 0.35–0.75), and 1-year mortality (OR 0.56, 95% CI 0.38–0.81).
  • Major bleeding complications showed a nonsignificant trend toward higher frequency in the invasive group (8.8% vs. 5.8%, P = 0.07).

Study Design

Type

Cohort (n=1,936)

Multicenter

Yes

Structured PICO

Does an invasive strategy reduce mortality and myocardial infarction in elderly patients (≥75 years) with NSTEMI compared to conservative treatment?

P
Population
1,936 elderly patients (≥75 years) with NSTEMI prospectively enrolled in the German Acute Coronary Syndromes registry to evaluate invasive versus conservative treatment.
E
Exposure
Invasive strategy (coronary angiography and/or revascularization)
C
Comparator
Conservative treatment
O
Outcome
In-hospital death and composite of death or non-fatal myocardial infarctionhard clinical

Main Result

Odds Ratio: 0.55 (95% CI 0.35–0.86)

Absolute Event Rate: 6% vs 12.5%

p-value: p=<0.0001

In elderly patients with NSTEMI, an invasive strategy is associated with significantly reduced in-hospital and 1-year mortality compared to conservative management, despite a trend toward increased bleeding.

Cite This Study

Bauer et al. (2007) conducted a cohort in non-ST-elevation myocardial infarction (NSTEMI) (n=1,936). Invasive strategy vs. Conservative treatment was evaluated on In-hospital mortality (OR 0.55, 95% CI 0.35-0.86, p=<0.0001). An invasive strategy in elderly patients with NSTEMI was associated with significantly lower in-hospital mortality compared to conservative treatment (adjusted OR 0.55; 95% CI 0.35-0.86).

synapsesocial.com/papers/6a9465ffd05beabec064d07chttps://doi.org/10.1093/eurheartj/ehm464
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Also Consider

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