Invasive Versus Conservative Strategy in Older Adults ≥75 Years of Age With Non–ST‐segment–Elevation Acute Coronary Syndrome: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials
Background Older adults with non–ST‐segment–elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions. Methods and Results We s...
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Wiley
2024-11-01
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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.124.036151 |
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| author | Amit Rout Mohamad B. Moumneh Kriti Kalra Sahib Singh Aakash Garg Vijay Kunadian Simone Biscaglia Mohamad A. Alkhouli Jennifer A. Rymer Wayne B. Batchelor Michael G. Nanna Abdulla A. Damluji |
| author_facet | Amit Rout Mohamad B. Moumneh Kriti Kalra Sahib Singh Aakash Garg Vijay Kunadian Simone Biscaglia Mohamad A. Alkhouli Jennifer A. Rymer Wayne B. Batchelor Michael G. Nanna Abdulla A. Damluji |
| author_sort | Amit Rout |
| collection | DOAJ |
| description | Background Older adults with non–ST‐segment–elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions. Methods and Results We searched for randomized controlled trials comparing invasive versus medical management or a selective invasive (conservative) strategy for older patients (age≥75 years) with non–ST‐segment–elevation acute coronary syndrome. Fixed effects meta‐analysis was conducted to estimate the odds ratio (OR) with 95% CI for the composite of death or myocardial infarction (MI) and individual secondary end points of all‐cause death, cardiovascular death, MI, revascularization, stroke, and major bleeding. Nine studies with 2429 patients (invasive: 1228 versus control: 1201) with a mean follow‐up of 21 months were included. An invasive strategy was associated with a significantly decreased risk of a composite of death and MI (OR, 0.67 [95% CI, 0.54–0.83], P<0.001), MI (OR, 0.56 [95% CI, 0.45–0.70], P<0.001) and subsequent revascularization (OR, 0.27 [95% CI, 0.16–0.48], P<0.001). There was no difference in all‐cause death (OR, 0.84 [95% CI, 0.65–1.10], P=0.21), cardiovascular death (OR, 0.85 [95% CI, 0.63–1.15], P=0.30), stroke (OR, 0.74 [95% CI, 0.38–1.47], P=0.39), or major bleeding (OR, 1.24 [95% CI, 0.42–3.66], P=0.70). Conclusions In older patients ≥75 years old with non–ST‐segment–elevation acute coronary syndrome, an invasive strategy reduced the risk of a composite of death and MI, MI, and subsequent revascularization compared with a conservative strategy alone. Older adults with higher burden of geriatric conditions should be included in future trials to improve generalizability to this growing population. |
| format | Article |
| id | doaj-art-9fbdc8da87c14b5b8933b476fa112161 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-9fbdc8da87c14b5b8933b476fa1121612025-08-20T01:54:22ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-11-01132110.1161/JAHA.124.036151Invasive Versus Conservative Strategy in Older Adults ≥75 Years of Age With Non–ST‐segment–Elevation Acute Coronary Syndrome: A Systematic Review and Meta‐Analysis of Randomized Controlled TrialsAmit Rout0Mohamad B. Moumneh1Kriti Kalra2Sahib Singh3Aakash Garg4Vijay Kunadian5Simone Biscaglia6Mohamad A. Alkhouli7Jennifer A. Rymer8Wayne B. Batchelor9Michael G. Nanna10Abdulla A. Damluji11Division of Cardiology University of Louisville Louisville KY USAInova Center of Outcomes Research Falls Church VA USAInova Center of Outcomes Research Falls Church VA USADepartment of Medicine Sinai Hospital of Baltimore Baltimore MD USADivision of Cardiology Ellis Hospital Schenectady NY USATranslational and Clinical Research Institute, Faculty of Medical Sciences Newcastle University Newcastle upon Tyne United KingdomAzienda Ospedaliero‐Universitaria di Ferrara Cona FE ItalyDepartment of Cardiology, Mayo Clinic School of Medicine Rochester MN USADuke University School of Medicine Durham NC USAInova Center of Outcomes Research Falls Church VA USAYale University School of Medicine New Haven CT USAInova Center of Outcomes Research Falls Church VA USABackground Older adults with non–ST‐segment–elevation acute coronary syndrome are less likely to undergo an invasive strategy compared with younger patients. Randomized controlled trials traditionally exclude older adults because of their high burden of geriatric conditions. Methods and Results We searched for randomized controlled trials comparing invasive versus medical management or a selective invasive (conservative) strategy for older patients (age≥75 years) with non–ST‐segment–elevation acute coronary syndrome. Fixed effects meta‐analysis was conducted to estimate the odds ratio (OR) with 95% CI for the composite of death or myocardial infarction (MI) and individual secondary end points of all‐cause death, cardiovascular death, MI, revascularization, stroke, and major bleeding. Nine studies with 2429 patients (invasive: 1228 versus control: 1201) with a mean follow‐up of 21 months were included. An invasive strategy was associated with a significantly decreased risk of a composite of death and MI (OR, 0.67 [95% CI, 0.54–0.83], P<0.001), MI (OR, 0.56 [95% CI, 0.45–0.70], P<0.001) and subsequent revascularization (OR, 0.27 [95% CI, 0.16–0.48], P<0.001). There was no difference in all‐cause death (OR, 0.84 [95% CI, 0.65–1.10], P=0.21), cardiovascular death (OR, 0.85 [95% CI, 0.63–1.15], P=0.30), stroke (OR, 0.74 [95% CI, 0.38–1.47], P=0.39), or major bleeding (OR, 1.24 [95% CI, 0.42–3.66], P=0.70). Conclusions In older patients ≥75 years old with non–ST‐segment–elevation acute coronary syndrome, an invasive strategy reduced the risk of a composite of death and MI, MI, and subsequent revascularization compared with a conservative strategy alone. Older adults with higher burden of geriatric conditions should be included in future trials to improve generalizability to this growing population.https://www.ahajournals.org/doi/10.1161/JAHA.124.036151agedcoronary diseasegeriatric assessmentmeta‐analysispercutaneous coronary intervention |
| spellingShingle | Amit Rout Mohamad B. Moumneh Kriti Kalra Sahib Singh Aakash Garg Vijay Kunadian Simone Biscaglia Mohamad A. Alkhouli Jennifer A. Rymer Wayne B. Batchelor Michael G. Nanna Abdulla A. Damluji Invasive Versus Conservative Strategy in Older Adults ≥75 Years of Age With Non–ST‐segment–Elevation Acute Coronary Syndrome: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aged coronary disease geriatric assessment meta‐analysis percutaneous coronary intervention |
| title | Invasive Versus Conservative Strategy in Older Adults ≥75 Years of Age With Non–ST‐segment–Elevation Acute Coronary Syndrome: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials |
| title_full | Invasive Versus Conservative Strategy in Older Adults ≥75 Years of Age With Non–ST‐segment–Elevation Acute Coronary Syndrome: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials |
| title_fullStr | Invasive Versus Conservative Strategy in Older Adults ≥75 Years of Age With Non–ST‐segment–Elevation Acute Coronary Syndrome: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Invasive Versus Conservative Strategy in Older Adults ≥75 Years of Age With Non–ST‐segment–Elevation Acute Coronary Syndrome: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials |
| title_short | Invasive Versus Conservative Strategy in Older Adults ≥75 Years of Age With Non–ST‐segment–Elevation Acute Coronary Syndrome: A Systematic Review and Meta‐Analysis of Randomized Controlled Trials |
| title_sort | invasive versus conservative strategy in older adults ≥75 years of age with non st segment elevation acute coronary syndrome a systematic review and meta analysis of randomized controlled trials |
| topic | aged coronary disease geriatric assessment meta‐analysis percutaneous coronary intervention |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.036151 |
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