Intervention therapy reduced 1-year MACCE by 38.4% (aHR 0.616) and NACE by 34.8% (aHR 0.652) versus conservative treatment in very elderly frail NSTEMI patients.
Does intervention therapy reduce net adverse clinical events in very elderly and frail patients with NSTEMI compared to conservative therapy?
In very elderly and frail patients with NSTEMI, an interventional strategy is associated with a significantly lower 1-year risk of net adverse clinical events compared to conservative management.
Absolute Event Rate: 0% vs 0%
Abstract Background Whether conservative therapy or intervention therapy is more beneficial of very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) and frailty remains unclear. Methods The data for this study were obtained from 82 secondary or tertiary hospitals between January 1, 2010, and March 31, 2024. Frailty was assessed using the Hospital Frailty Risk Score (HFRS). Very elderly (≥85 years) and frail (HFRS score≥5) patients with NSTEMI were divided into intervention therapy group and conservative therapy group. Baseline characteristics were balanced using propensity score matching (PSM, 1:1 and 1:3) and stabilized inverse probability of treatment-weighting (IPTW) to reduce potential selection bias. The primary outcome was net adverse clinical events (NACEs) defined as major adverse cardiac or cerebral events (MACCE, including cardiac death, myocardial infarction, stroke or any revascularization) and bleeding events (BARC grade≥3) during 1-year follow up. Survival was plotted with Kaplan-Meier curve. Results We finally enrolled 3,478 patients, among them 351 patients received intervention treatment and 3,127 received conservative treatment. The 1:1 PSM cohort included 288 patient pairs.The 1:3 PSM cohort created 335 patients in the intervention therapy group and 844 patients in the conservative therapy group.In the IPTW cohort, there were 4496 patients in the intervention therapy group and 3483 patients in the conservative therapy group.Multivariate Cox regression analysis revealed that intervention treatment reduced 1-year MACCE (aHR95%CI = 0.6160.482-0.788,P 0.001) and NACE (aHR95%CI = 0.6520.513-0.827,P 0.001). These findings remained consistent in the 1:1 matched cohort (n = 576) (MACCE: aHR 95%CI= 0.6720.482-0.938,P 0.001; NACE: aHR95%CI = 0.708, 0.512-0.981,P 0.001).Kaplan-Meier curve analysis also revealed a significant reduction in the incidence of MACCE rate (23.3% vs 33.0%, P 0.001)and NACE rate (24.7% vs 33.3%, P 0.001) in intervention group compared to the conservative group.Similar results were obtained by 1:3 PSM and IPTW cohorts. Conclusion In this multi-center study, the very elderly patients with NSTEMI who concurrently afflicted by frailty treated with intervention treatment exhibit improved outcomes.Flow diagram of participant selection Kaplan-Meier curve
Yang et al. (Sat,) reported a other. Intervention therapy reduced 1-year MACCE by 38.4% (aHR 0.616) and NACE by 34.8% (aHR 0.652) versus conservative treatment in very elderly frail NSTEMI patients.