Key result
An invasive strategy significantly reduced the incidence of the composite endpoint compared with a conservative strategy in patients aged ≥80 years with NSTE-ACS (RR 0.727; 95% CI 0.619-0.855; P<0.001).
Why the study?
The optimal treatment strategy in patients older than 80 years with non-ST-segment elevation acute coronary syndrome remained to be investigated.
Does an invasive strategy reduce the composite endpoint in patients aged 80 years or older with NSTE-ACS compared to a conservative strategy?
Meta-Analysis (n=893)
Does an invasive strategy reduce the composite endpoint in patients aged 80 years or older with NSTE-ACS compared to a conservative strategy?
In very elderly patients (≥80 years) with NSTE-ACS, an invasive strategy reduces the composite endpoint, recurrent MI, and revascularization without increasing major bleeding, though it does not improve mortality.
Invasive strategy reduces ischemic events without mortality or bleeding trade-offs in octogenarians with NSTE-ACS; reinforces individualized decisions in this population.
Aim To investigate the optimal treatment strategy in patients older than 80 years with non‐ST‐segment elevation acute coronary syndrome (NSTE‐ACS). Methods All published randomized, placebo‐controlled trials (RCTs) reporting on comparisons between invasive and conservative strategies for patients aged 80 years or older with NSTE‐ACS were identified. The literature search was performed using PubMed, EMBASE, Cochrane Library, and the ISI Web of Science, from their establishment to July 2021 with no language restriction. The pooled risk ratios (RRs) with 95% confidence intervals (CI) for dichotomous outcomes were calculated. Results Three RCTs involving a total of 893 cases met the inclusion criteria. Compared with the conservative group, the invasive strategy could significantly improve the incidence rate of composite endpoint (I2 = 21.9%; RR 0.727, 95% CI 0.619 to 0.855, P < 0.001), recurrent myocardial infarction (MI) (I2 = 0.0%; RR 0.585, 95% CI 0.441 to 0.776, P < 0.001) and revascularization (I2 = 0.0%; RR 0.239, 95% CI 0.126 to 0.455, P < 0.001). However, no benefits were observed on outcomes of all‐cause death (I2 = 0.0%; RR 0.888, 95% CI 0.681 to 1.160, P = 0.384), cardiac death (I2 = 0.0%; RR 0.769, 95% CI 0.412 to 1.433, P = 0.408) and stroke (I2 = 0.0%; RR 0.778, 95% CI 0.392 to 1.543, P = 0.473). The major bleeding events were comparable between the two groups (I2 = 0.0%; RR 1.582, 95% CI 0.622 to 4.025, P = 0.336). Conclusions Compared with a conservative strategy, the invasive treatment could reduce the incidence of composite endpoint, recurrent MI, and revascularization in the very elderly with NSTE‐ACS. However, no benefits were observed on mortality. Geriatr Gerontol Int 2022; 22: 36–41.
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Wang et al. (2021) conducted a meta-analysis in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) (n=893). Invasive strategy vs. Conservative strategy was evaluated on composite endpoint (RR 0.727, 95% CI 0.619 to 0.855, p=< 0.001). An invasive strategy significantly reduced the incidence of the composite endpoint compared with a conservative strategy in patients aged ≥80 years with NSTE-ACS (RR 0.727; 95% CI 0.619-0.855; P<0.001).
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