Key result
Contemporary elderly NSTEMI management yields a ~14% 1-year major cardiovascular event rate.
Why the study?
The current treatment patterns and risks of cardiovascular and bleeding events in elderly patients with NSTEMI were not well described in a national registry.
Cohort (n=646)
Yes
Elderly patients with NSTEMI face a 1-year cardiovascular risk that is three times higher than their bleeding risk, emphasizing the importance of balancing antithrombotic and revascularization strategies.
Highlights predominant CV over bleeding risk in elderly NSTEMI; leaves open optimal strategies pending randomized data.
Objective We describe the current treatment of elderly patients with non-ST-elevation myocardial infarction (NSTEMI) enrolled in a national registry. Methods The POPular AGE registry is a prospective, multicentre study of patients ≥ 75 years of age presenting with NSTEMI, performed in the Netherlands. Management was at the discretion of the treating physician. Cardiovascular events consisted of cardiovascular death, myocardial infarction and ischaemic stroke. Bleeding was classified according to the Bleeding Academic Research Consortium (BARC) criteria. Results A total of 646 patients were enrolled between August 2016 and May 2018. Median age was 81 (IQR 77–84) years and 58% were male. Overall, 75% underwent coronary angiography, 40% percutaneous coronary intervention, and 11% coronary artery bypass grafting, while 49.8% received pharmacological therapy only. At discharge, dual antiplatelet therapy (aspirin and P2Y12 inhibitor) was prescribed to 56.7%, and 27.4% received oral anticoagulation plus at least one antiplatelet agent. At 1‑year follow-up, cardiovascular death, myocardial infarction or stroke had occurred in 13.6% and major bleeding (BARC 3 and 5) in 3.9% of patients. The risk of both cardiovascular events and major bleeding was highest during the 1st month. However, cardiovascular risk was three times as high as bleeding risk in this elderly population, both after 1 month and after 1 year. Conclusions In this national registry of elderly patients with NSTEMI, the majority are treated according to current European Society of Cardiology guidelines. Both the cardiovascular and bleeding risk are highest during the 1st month after NSTEMI. However, the cardiovascular risk was three times as high as the bleeding risk.
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Gimbel et al. (2023) conducted a cohort in Non-ST-elevation myocardial infarction (NSTEMI) (n=646). Contemporary NSTEMI management was evaluated on Composite of cardiovascular death, myocardial infarction, or ischemic stroke at 1 year. In a nationwide registry of elderly patients with NSTEMI, contemporary management resulted in a 1-year rate of cardiovascular death, myocardial infarction, or stroke of 13.6% and a major bleeding rate of 3.9%.
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