Effect of an invasive strategy on in-hospital outcome in elderly patients with non-ST-elevation myocardial infarction

• Published in: European heart journal 2007-12, Vol.28 (23), p.2873-2878
• Main Authors: Bauer, Timm, Koeth, Oliver, Jünger, Claus, Heer, Tobias, Wienbergen, Harm, Gitt, Anselm, Zahn, Ralf, Senges, Jochen, Zeymer, Uwe
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - methods; Cardiac Surgical Procedures - mortality; Cardiology. Vascular system; Cardiovascular system; Coronary angiography; Coronary Angiography - methods; Coronary Angiography - mortality; Coronary Artery Bypass - adverse effects; Coronary Artery Bypass - methods; Coronary Artery Bypass - mortality; Coronary heart disease; Female; Follow-Up Studies; Heart; Hospital Mortality; Humans; Invasive strategy; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocardial Revascularization - methods; Myocardial Revascularization - mortality; Non ST-elevation myocardial infarction; Postoperative Hemorrhage - etiology; Prospective Studies; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Revascularization; Risk Assessment; Risk Factors; Treatment Outcome
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehm464

Aims We sought to investigate the impact of an invasive treatment in elderly patients presenting with non-ST elevation myocardial infarction (NSTEMI) in clinical practice. Methods and results We analysed data of consecutive elderly patients (≥75 years) with NSTEMI who were prospectively enrolled in the German Acute Coronary Syndromes registry between July 2000 and November 2002. Overall 1936 patients were divided into two groups: 1005 (51.9%) underwent coronary angiography and/or revascularization, 931 (48.1%) received conservative treatment. In the invasive group, percutaneous coronary intervention was performed in 37.5% within 48 h and in 17.6% after 48 h, whereas 9.8% underwent coronary artery bypass grafting within the hospital stay. In-hospital death (12.5 vs. 6.0%, P < 0.0001) and death/myocardial infarction (17.3 vs. 9.6%, P < 0.0001) occurred significantly less often in patients with invasive strategy. After adjustment of the confounding factors in the propensity score analysis the invasive strategy remained superior for mortality (OR 0.55, 95% CI 0.35–0.86) and death and non-fatal myocardial infarction (OR 0.51, 95% CI 0.35–0.75) and 1 year mortality (OR 0.56, 95% CI 0.38–0.81). Major bleeding complications tended to be more frequent in the invasive group (8.8 vs. 5.8%, P = 0.07). Conclusion In clinical practice, in elderly patients with NSTEMI, an invasive strategy is associated with an improved in-hospital and 1 year outcome but a trend towards more bleeding complications.