Invasive vs. conservative management of older patients with non-ST-elevation acute coronary syndrome: individual...

Area of Science:

• Cardiology
• Geriatric Medicine
• Interventional Cardiology

Background:

• Older patients with non-ST-elevation acute coronary syndrome (NSTEACS) often receive less guideline-recommended care.
• Evidence on interventional management strategies for elderly NSTEACS patients is limited.
• This study addresses the scarcity of data on invasive vs. conservative strategies in this population.

Purpose of the Study:

• To assess the impact of routine invasive versus conservative management in older patients (>70 years) with NSTEACS.
• Utilized individual patient data (IPD) from randomized controlled trials (RCTs).
• Evaluated the primary endpoint of all-cause mortality and myocardial infarction (MI) at 1 year.

Main Methods:

• Systematic literature search of MEDLINE, Web of Science, and Scopus (2010-2023).
• Included RCTs comparing routine invasive and conservative strategies in NSTEACS patients >70 years.
• Employed one-stage IPD meta-analysis using random-effects and fixed-effect Cox models.

Main Results:

• Six RCTs with 1479 participants were analyzed.
• No significant difference in the composite endpoint of all-cause mortality and MI at 1 year (HR 0.87, P=.43).
• Significantly lower hazard for MI (HR 0.62, P=.006) and urgent revascularization (HR 0.41, P=.037) in the invasive group.

Conclusions:

• Routine invasive treatment for NSTEACS in older adults does not reduce 1-year all-cause mortality or MI composite risk.
• Invasive management significantly reduces the risk of repeat MI and the need for urgent revascularization.
• Further research from ongoing large clinical trials is warranted.