Meta-Analysis on Invasive Versus Conservative Strategy in Patients Older Than Seventy Years With Non-ST Elevation Myocardial Infarction

• Published in: The American journal of cardiology 2023-01, Vol.186, p.66-70
• Main Authors: Khalil, Mahmoud, Maqsood, Muhammad Haisum, Basir, Mir B., Saad, Marwan, Yassa, George, Hakam, Laila, Abraham, Joseph, Hennawy, Bassam S., Etriby, Shehab El, Ribeiro, Marcelo Harada, Ong, Kenneth, Garcia, Santiago, Brilakis, Emmanouil S., Alaswad, Khaldoon, Megaly, Michael
• Format: Article
• Language: English
• Subjects: Age; Aged; Angina, Unstable; Angioplasty; Bias; Bleeding; Cardiology; Cardiovascular disease; Child, Preschool; Clinical trials; Conservative Treatment; Coronary vessels; Heart; Heart attacks; Heart surgery; Humans; Meta-analysis; Morbidity; Mortality; Myocardial infarction; Myocardial Infarction - epidemiology; Myocardial Infarction - therapy; Myocardial Revascularization; Non-ST Elevated Myocardial Infarction - epidemiology; Non-ST Elevated Myocardial Infarction - therapy; Patients; Risk assessment; Strategy; Treatment Outcome
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2022.10.011

Management of non-ST elevation myocardial infarction (NSTEMI) has evolved over the years, but most published data are from younger patients. Data on the NSTEMI management in older patients remain limited. We performed a meta-analysis of randomized controlled trials to evaluate the long-term outcomes of invasive versus conservative strategies in older patients (>70 years old) with NSTEMI. Of 1,550 reports searched, 4 randomized controlled trials (1,126 patients) were included in the analysis, with a median follow-up of 1.25 years (range: 1 to 2.5 years). The median age of included patients was 83.6 (interquartile range: 2.8 years). The invasive strategy was associated with significantly lower risk of major adverse cardiac and cerebrovascular event (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.40 to 0.91, I2 = 54%; 3 trials] and unplanned revascularization (OR 0.31, 95% CI 0.15 to 0.64, I2 = 1.7%; 3 trials] than was the conservative strategy. There was no difference in all-cause mortality (OR 0.88, 95% CI 0.65 to 1.18, I2 = 0%; 4 trials], myocardial infarction (OR 0.70, 95% CI 0.42 to 1.19, I2 = 54.7%; 4 trials], or bleeding (OR 0.87, 95% CI 0.39 to 1.93, I2 = 0%; 3 trials] between the strategies. In conclusion, the use of initial invasive strategy in older patients presenting with NSTEMI was associated with a significantly lower risk of major adverse cardiac and cerebrovascular event and unplanned revascularization than that of the initial conservative strategy without increased bleeding.