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. 2019 Oct;16(10):741-748.
doi: 10.11909/j.issn.1671-5411.2019.10.006.

Invasive versus conservative strategy in consecutive patients aged 80 years or older with non-ST-segment elevation myocardial infarction: a retrospective study in China

Yong-Gang Sui  1 , Si-Yong Teng  1 , Jie Qian  1 , Yuan Wu  1 , Ke-Fei Dou  1 , Yi-Da Tang  1 , Shu-Bin Qiao  1 , Yong-Jian Wu  1
Affiliations

Invasive versus conservative strategy in consecutive patients aged 80 years or older with non-ST-segment elevation myocardial infarction: a retrospective study in China

Yong-Gang Sui et al. J Geriatr Cardiol. 2019 Oct.

Abstract

Objective: To investigate whether the very elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) will benefit from an invasive strategy versus a conservative strategy.

Methods: 190 consecutive patients aged 80 years or older with NSTEMI were included in the retrospective study from September 2014 to August 2017, of which 69 patients received conservative strategy and 121 patients received invasive strategy. The primary outcome was death. Multivariate Cox regression models were used to assess the statistical association between strategies and mortality. The survival probability was further analyzed.

Results: The primary outcome occurred in 17.4% patients in the invasive group and in 42.0% patients in the conservative group (P = 0.0002). The readmission rate in the invasive group (14.9%) was higher than that in the conservative group (7.2%). Creatinine level (OR = 1.01, 95% CI: 0.10-1.03, P = 0.05) and use of diuretic (OR = 3.65, 95% CI: 1.56-8.53, P = 0.003) were independent influential factors for invasive strategy. HRs for multivariate Cox regression models were 3.45 (95% CI: 1.77-6.75, P = 0.0003), 3.02 (95% CI: 1.52-6.01, P = 0.0017), 2.93 (95% CI: 1. 46-5.86, P = 0.0024) and 2.47 (95% CI: 1.20-5.07, P = 0.0137). Compared with the patients received invasive strategy, the conservative group had remarkably reduced survival probability with time since treatment (P < 0.001).

Conclusions: An invasive strategy is superior to a conservative strategy in reducing mortality of patients aged 80 years or older with NSTEMI. Our results suggest that an invasive strategy is more suitable for the very elderly patients with NSTEMI in China.

Keywords: Conservative strategy; Death; Invasive strategy; Non-ST-segment elevation myocardial infarction.

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Figures

Figure 1.
Figure 1.. Multivariate Cox regression models for accessing the association between the invasive and conservative strategies and mortality.
Model 1: unadjusted model; Model 2: adjusted for age, gender; Model 3: adjusted for age, gender, hypertension, diabetes, hyperlipemia, anemia; and Model 4: adjusted for age, gender, hypertension, diabetes, hyperlipemia, anemia, previous myocardial infarction, previous CABG, III degree atrioventricular block and renal insufficiency. The conservative strategy compared with the invasive strategy, P < 0.05. CABG: coronary artery bypass graft.
Figure 2.
Figure 2.. Survival probability of the invasive strategy versus the conservative strategy.
The invasive strategy compared with conservative strategy, P < 0.001. NSTEMI: non-ST-segment elevation myocardial infarction.
See this image and copyright information in PMC

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