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Invasive vs. conservative management of older patients with non-ST-elevation acute coronary syndrome: individual patient data meta-analysis.
Kotanidis, Christos P; Mills, Gregory B; Bendz, Bjørn; Berg, Erlend S; Hildick-Smith, David; Hirlekar, Geir; Milasinovic, Dejan; Morici, Nuccia; Myat, Aung; Tegn, Nicolai; Sanchis, Juan; Savonitto, Stefano; De Servi, Stefano; Fox, Keith A A; Pocock, Stuart; Kunadian, Vijay.
Afiliación
  • Kotanidis CP; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK.
  • Mills GB; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, High Heaton NE7 7DN, United Kingdom.
  • Bendz B; Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK.
  • Berg ES; Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, High Heaton NE7 7DN, United Kingdom.
  • Hildick-Smith D; Department of Cardiology, Oslo University Hospital, Oslo, Norway.
  • Hirlekar G; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
  • Milasinovic D; Department of Cardiology, Oslo University Hospital, Oslo, Norway.
  • Morici N; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
  • Myat A; Sussex Cardiac Centre, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
  • Tegn N; Department of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden.
  • Sanchis J; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
  • Savonitto S; Department of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia.
  • De Servi S; Medical Faculty, University of Belgrade, Belgrade, Serbia.
  • Fox KAA; IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.
  • Pocock S; Medpace UK, London, UK.
  • Kunadian V; Department of Cardiology, Oslo University Hospital, Oslo, Norway.
Eur Heart J ; 45(23): 2052-2062, 2024 Jun 14.
Article en En | MEDLINE | ID: mdl-38596853
ABSTRACT
BACKGROUND AND

AIMS:

Older patients with non-ST-elevation acute coronary syndrome (NSTEACS) are less likely to receive guideline-recommended care including coronary angiography and revascularization. Evidence-based recommendations regarding interventional management strategies in this patient cohort are scarce. This meta-analysis aimed to assess the impact of routine invasive vs. conservative management of NSTEACS by using individual patient data (IPD) from all available randomized controlled trials (RCTs) including older patients.

METHODS:

MEDLINE, Web of Science and Scopus were searched between 1 January 2010 and 11 September 2023. RCTs investigating routine invasive and conservative strategies in persons >70 years old with NSTEACS were included. Observational studies or trials involving populations outside the target range were excluded. The primary endpoint was a composite of all-cause mortality and myocardial infarction (MI) at 1 year. One-stage IPD meta-analyses were adopted by use of random-effects and fixed-effect Cox models. This meta-analysis is registered with PROSPERO (CRD42023379819).

RESULTS:

Six eligible studies were identified including 1479 participants. The primary endpoint occurred in 181 of 736 (24.5%) participants in the invasive management group compared with 215 of 743 (28.9%) participants in the conservative management group with a hazard ratio (HR) from random-effects model of 0.87 (95% CI 0.63-1.22; P = .43). The hazard for MI at 1 year was significantly lower in the invasive group compared with the conservative group (HR from random-effects model 0.62, 95% CI 0.44-0.87; P = .006). Similar results were seen for urgent revascularization (HR from random-effects model 0.41, 95% CI 0.18-0.95; P = .037). There was no significant difference in mortality.

CONCLUSIONS:

No evidence was found that routine invasive treatment for NSTEACS in older patients reduces the risk of a composite of all-cause mortality and MI within 1 year compared with conservative management. However, there is convincing evidence that invasive treatment significantly lowers the risk of repeat MI or urgent revascularisation. Further evidence is needed from ongoing larger clinical trials.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Síndrome Coronario Agudo / Intervención Coronaria Percutánea / Tratamiento Conservador Límite: Aged / Female / Humans Idioma: En Revista: Eur Heart J Año: 2024 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Reino Unido
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Síndrome Coronario Agudo / Intervención Coronaria Percutánea / Tratamiento Conservador Límite: Aged / Female / Humans Idioma: En Revista: Eur Heart J Año: 2024 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Reino Unido