Invasive Versus Conservative Management Among Older Adult Patients With Non–ST‐Segment–Elevation Myocardial Infarction: A Meta‐Analysis of Randomized Controlled Trials
Background Older adult patients have been underrepresented in the pivotal trials comparing an invasive versus conservative management for non–ST‐segment–elevation myocardial infarction (NSTEMI). Methods We performed an electronic search of MEDLINE, Embase, and Cochrane databases through September 20...
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| Format: | Article |
| Language: | English |
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Wiley
2025-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.039601 |
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| author | Mohamed Hamed El‐Moatasem Gabr Wissam Harmouch Shani Scwartz Phillip Habib Islam Y. Elgendy Anthony Bavry Hani Jneid Emmanouil S. Brilakis Ayman Elbadawi |
| author_facet | Mohamed Hamed El‐Moatasem Gabr Wissam Harmouch Shani Scwartz Phillip Habib Islam Y. Elgendy Anthony Bavry Hani Jneid Emmanouil S. Brilakis Ayman Elbadawi |
| author_sort | Mohamed Hamed |
| collection | DOAJ |
| description | Background Older adult patients have been underrepresented in the pivotal trials comparing an invasive versus conservative management for non–ST‐segment–elevation myocardial infarction (NSTEMI). Methods We performed an electronic search of MEDLINE, Embase, and Cochrane databases through September 2024 for randomized controlled trials comparing invasive versus conservative management of NSTEMI in patients aged ≥70 years. Results The final analysis included 7 randomized controlled trials with 2997 patients. The weighted mean follow‐up time was 47.1 months, and the mean age was 82.6 years. There was no significant difference in all‐cause mortality between an invasive versus a conservative management approach (27.9% versus 26.6%; risk ratio [RR], 1.05 [95% CI, 0.94–1.18]; I2=0%). There was a statistically nonsignificant trend for fewer major adverse cardiac events in the invasive group (28.3% versus 33.4%; RR, 0.82 [95% CI, 0.68–1.00]; P=0.05, I2=58%). An invasive approach was associated with a lower risk of recurrent myocardial infarction (RR, 0.76 [95% CI, 0.60–0.97]) and ischemia‐driven revascularization (RR, 0.29 [95% CI, 0.21–0.40]) without an increase in major bleeding (RR, 1.31 [95% CI, 0.86–1.97]) compared with a conservative approach. There were no significant differences between both approaches in cardiovascular mortality, acute cerebrovascular events, or length of hospital stay. Conclusions Among older adult patients with NSTEMI, there was no significant difference in survival between an invasive or a conservative approach. An invasive approach was associated with a lower risk of recurrent myocardial infarction and ischemia‐driven revascularization without an increase in the risk of major bleeding. The findings should help with informed decision‐making among older adult patients with NSTEMI. |
| format | Article |
| id | doaj-art-2ea5b1d6c1e2499194d9e2ffd4a914ad |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-2ea5b1d6c1e2499194d9e2ffd4a914ad2025-08-20T03:30:20ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-07-01141410.1161/JAHA.124.039601Invasive Versus Conservative Management Among Older Adult Patients With Non–ST‐Segment–Elevation Myocardial Infarction: A Meta‐Analysis of Randomized Controlled TrialsMohamed Hamed0El‐Moatasem Gabr1Wissam Harmouch2Shani Scwartz3Phillip Habib4Islam Y. Elgendy5Anthony Bavry6Hani Jneid7Emmanouil S. Brilakis8Ayman Elbadawi9Division of Cardiology Florida Atlantic University Boca Raton FL USADivision of Cardiology Houston Methodist DeBakey Heart & Vascular Center Houston TX USADepartment of Internal Medicine University of Texas Medical Branch Galveston TX USADepartment of Internal Medicine Florida Atlantic University Boca Raton FL USADivision of Cardiology Florida Atlantic University Boca Raton FL USADivision of Cardiovascular Medicine Gill Heart and Vascular Institute, University of Kentucky Lexington KY USADivision of Cardiology University of Texas Southwestern Medical Center Dallas TX USADivision of Cardiology University of Texas Medical Branch Galveston TX USAMinneapolis Heart Institute and Minneapolis Heart Institute Foundation Abbott Northwestern Hospital Minneapolis MN USATexas A&M School of Medicine Bryan TX USABackground Older adult patients have been underrepresented in the pivotal trials comparing an invasive versus conservative management for non–ST‐segment–elevation myocardial infarction (NSTEMI). Methods We performed an electronic search of MEDLINE, Embase, and Cochrane databases through September 2024 for randomized controlled trials comparing invasive versus conservative management of NSTEMI in patients aged ≥70 years. Results The final analysis included 7 randomized controlled trials with 2997 patients. The weighted mean follow‐up time was 47.1 months, and the mean age was 82.6 years. There was no significant difference in all‐cause mortality between an invasive versus a conservative management approach (27.9% versus 26.6%; risk ratio [RR], 1.05 [95% CI, 0.94–1.18]; I2=0%). There was a statistically nonsignificant trend for fewer major adverse cardiac events in the invasive group (28.3% versus 33.4%; RR, 0.82 [95% CI, 0.68–1.00]; P=0.05, I2=58%). An invasive approach was associated with a lower risk of recurrent myocardial infarction (RR, 0.76 [95% CI, 0.60–0.97]) and ischemia‐driven revascularization (RR, 0.29 [95% CI, 0.21–0.40]) without an increase in major bleeding (RR, 1.31 [95% CI, 0.86–1.97]) compared with a conservative approach. There were no significant differences between both approaches in cardiovascular mortality, acute cerebrovascular events, or length of hospital stay. Conclusions Among older adult patients with NSTEMI, there was no significant difference in survival between an invasive or a conservative approach. An invasive approach was associated with a lower risk of recurrent myocardial infarction and ischemia‐driven revascularization without an increase in the risk of major bleeding. The findings should help with informed decision‐making among older adult patients with NSTEMI.https://www.ahajournals.org/doi/10.1161/JAHA.124.039601ACSconservativeinvasiveNSTEMIolder adults |
| spellingShingle | Mohamed Hamed El‐Moatasem Gabr Wissam Harmouch Shani Scwartz Phillip Habib Islam Y. Elgendy Anthony Bavry Hani Jneid Emmanouil S. Brilakis Ayman Elbadawi Invasive Versus Conservative Management Among Older Adult Patients With Non–ST‐Segment–Elevation Myocardial Infarction: A Meta‐Analysis of Randomized Controlled Trials Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease ACS conservative invasive NSTEMI older adults |
| title | Invasive Versus Conservative Management Among Older Adult Patients With Non–ST‐Segment–Elevation Myocardial Infarction: A Meta‐Analysis of Randomized Controlled Trials |
| title_full | Invasive Versus Conservative Management Among Older Adult Patients With Non–ST‐Segment–Elevation Myocardial Infarction: A Meta‐Analysis of Randomized Controlled Trials |
| title_fullStr | Invasive Versus Conservative Management Among Older Adult Patients With Non–ST‐Segment–Elevation Myocardial Infarction: A Meta‐Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Invasive Versus Conservative Management Among Older Adult Patients With Non–ST‐Segment–Elevation Myocardial Infarction: A Meta‐Analysis of Randomized Controlled Trials |
| title_short | Invasive Versus Conservative Management Among Older Adult Patients With Non–ST‐Segment–Elevation Myocardial Infarction: A Meta‐Analysis of Randomized Controlled Trials |
| title_sort | invasive versus conservative management among older adult patients with non st segment elevation myocardial infarction a meta analysis of randomized controlled trials |
| topic | ACS conservative invasive NSTEMI older adults |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.039601 |
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