TY - JOUR
T1 - Conservative versus Invasive Strategy in Elderly Patients with Non-ST-Elevation Myocardial Infarction
T2 - Insights from the International POPular Age Registry
AU - Van den Broek, Wout W. A.
AU - Gimbel, Marieke E.
AU - Yin, Dean R. P. P. Chan Pin
AU - Azzahhafi, Jaouad
AU - Hermanides, Renicus S.
AU - Runnett, Craig
AU - Storey, Robert F.
AU - Austin, David
AU - Oemrawsingh, Rohit
AU - Cooke, Justin
AU - Galasko, Gavin
AU - Walhout, Ronald J.
AU - Schellings, Dirk A. A. M.
AU - Brinckman, Stijn L.
AU - The, Hong Kie
AU - Stoel, Martin G.
AU - Heestermans, Antonius A. C. M.
AU - Nicastia, Debby
AU - Emans, Mireille E.
AU - Van 't Hof, Arnoud W. J.
AU - Alber, Hannes
AU - Gerber, Robert
AU - Van Bergen, Paul F. M. M.
AU - Aksoy, Ismail
AU - Nasser, Abdul
AU - Knaapen, Paul
AU - Botman, Cees-Joost
AU - Liem, Anho
AU - Kelder, Johannes C.
AU - ten Berg, Jurrien M.
PY - 2023/9/1
Y1 - 2023/9/1
N2 - This registry assessed the impact of conservative and invasive strategies on major adverse clinical events (MACE) in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). Patients aged & GE;75 years with NSTEMI were prospectively registered from European centers and followed up for one year. Outcomes were compared between conservative and invasive groups in the overall population and a propensity score-matched (PSM) cohort. MACE included cardiovascular death, acute coronary syndrome, and stroke. The study included 1190 patients (median age 80 years, 43% female). CAG was performed in 67% (N = 798), with two-thirds undergoing revascularization. Conservatively treated patients had higher baseline risk. After propensity score matching, 319 patient pairs were successfully matched. MACE occurred more frequently in the conservative group (total population 20% vs. 12%, adjHR 0.53, 95% CI 0.37-0.77, p = 0.001), remaining significant in the PSM cohort (18% vs. 12%, adjHR 0.50, 95% CI 0.31-0.81, p = 0.004). In conclusion, an early invasive strategy was associated with benefits over conservative management in elderly patients with NSTEMI. Risk factors associated with ischemia and bleeding should guide strategy selection rather than solely relying on age.
AB - This registry assessed the impact of conservative and invasive strategies on major adverse clinical events (MACE) in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). Patients aged & GE;75 years with NSTEMI were prospectively registered from European centers and followed up for one year. Outcomes were compared between conservative and invasive groups in the overall population and a propensity score-matched (PSM) cohort. MACE included cardiovascular death, acute coronary syndrome, and stroke. The study included 1190 patients (median age 80 years, 43% female). CAG was performed in 67% (N = 798), with two-thirds undergoing revascularization. Conservatively treated patients had higher baseline risk. After propensity score matching, 319 patient pairs were successfully matched. MACE occurred more frequently in the conservative group (total population 20% vs. 12%, adjHR 0.53, 95% CI 0.37-0.77, p = 0.001), remaining significant in the PSM cohort (18% vs. 12%, adjHR 0.50, 95% CI 0.31-0.81, p = 0.004). In conclusion, an early invasive strategy was associated with benefits over conservative management in elderly patients with NSTEMI. Risk factors associated with ischemia and bleeding should guide strategy selection rather than solely relying on age.
KW - coronary artery disease
KW - non-ST-elevation myocardial infarction
KW - elderly
KW - conservative strategy
KW - invasive strategy
KW - ACUTE CORONARY SYNDROMES
KW - OPEN-LABEL
KW - OLDER
KW - MANAGEMENT
KW - CLOPIDOGREL
KW - TICAGRELOR
KW - OUTCOMES
U2 - 10.3390/jcm12175450
DO - 10.3390/jcm12175450
M3 - Article
SN - 2077-0383
VL - 12
JO - Journal of Clinical Medicine
JF - Journal of Clinical Medicine
IS - 17
M1 - 5450
ER -