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. 2023 Aug 22;12(17):5450.
doi: 10.3390/jcm12175450.

Conservative versus Invasive Strategy in Elderly Patients with Non-ST-Elevation Myocardial Infarction: Insights from the International POPular Age Registry

Wout W A van den Broek  1 , Marieke E Gimbel  1 , Dean R P P Chan Pin Yin  1 , Jaouad Azzahhafi  1 , Renicus S Hermanides  2 , Craig Runnett  3 , Robert F Storey  4 , David Austin  5 , Rohit Oemrawsingh  6 , Justin Cooke  7 , Gavin Galasko  8 , Ronald J Walhout  9 , Dirk A A M Schellings  10 , Stijn L Brinckman  11 , Hong Kie The  12 , Martin G Stoel  13 , Antonius A C M Heestermans  14 , Debby Nicastia  15 , Mireille E Emans  16 , Arnoud W J van 't Hof  17   18   19 , Hannes Alber  20 , Robert Gerber  21 , Paul F M M van Bergen  22 , Ismail Aksoy  23 , Abdul Nasser  24 , Paul Knaapen  25 , Cees-Joost Botman  26 , Anho Liem  27 , Johannes C Kelder  1 , Jurriën M Ten Berg  1   18
Affiliations

Conservative versus Invasive Strategy in Elderly Patients with Non-ST-Elevation Myocardial Infarction: Insights from the International POPular Age Registry

Wout W A van den Broek et al. J Clin Med. .

Abstract

This registry assessed the impact of conservative and invasive strategies on major adverse clinical events (MACE) in elderly patients with non-ST-elevation myocardial infarction (NSTEMI). Patients aged ≥75 years with NSTEMI were prospectively registered from European centers and followed up for one year. Outcomes were compared between conservative and invasive groups in the overall population and a propensity score-matched (PSM) cohort. MACE included cardiovascular death, acute coronary syndrome, and stroke. The study included 1190 patients (median age 80 years, 43% female). CAG was performed in 67% (N = 798), with two-thirds undergoing revascularization. Conservatively treated patients had higher baseline risk. After propensity score matching, 319 patient pairs were successfully matched. MACE occurred more frequently in the conservative group (total population 20% vs. 12%, adjHR 0.53, 95% CI 0.37-0.77, p = 0.001), remaining significant in the PSM cohort (18% vs. 12%, adjHR 0.50, 95% CI 0.31-0.81, p = 0.004). In conclusion, an early invasive strategy was associated with benefits over conservative management in elderly patients with NSTEMI. Risk factors associated with ischemia and bleeding should guide strategy selection rather than solely relying on age.

Keywords: conservative strategy; coronary artery disease; elderly; invasive strategy; non-ST-elevation myocardial infarction.

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Conflict of interest statement

JtB report grants from the Netherlands Organization for Health Research and Development, a Dutch government institution called ZonMw, and AstraZeneca; and personal fees from AstraZeneca, Boehringer Ingelheim, Bayer, Ferrer, Pfizer, and Merck, outside the submitted work. RFS reports research grants and personal fees from AstraZeneca, Cytosorbents, GlyCardial Diagnostics and Thromboserin; and personal fees from Alnylam, Bayer, Bristol Myers Squibb/Pfizer, Chiesi, CSL Behring, Daiichi Sankyo, HengRui, Idorsia, Intas Pharmaceuticals, Medscape, Novartis, PhaseBio, and Sanofi Aventis. DA reports research grants from TA Sciences, and personal fees from Philips/Volcano, Pfizer, Astra Zeneca and Novartis. AvH reports unrestricted grants to institution from Medtronic, AZ, Boehringer Ingelheim, Abbott. All other authors have no conflict of interests to declare.

Figures

Figure 1
Figure 1
Flowchart of the study. NSTEMI = non-ST-elevation myocardial infarction.
Figure 2
Figure 2
Kaplan Meier Curve for major adverse cardiovascular events (MACE) and Net Adverse Clinical Events (NACE) in the invasive and conservative groups. (A) Kaplan Meier Curve for MACE and Net Adverse Clinical Events (NACE) in the total population before propensity score matching. (B) Kaplan Meier Curve for MACE after propensity score matching. (C) Kaplan Meier Curve for NACE in the total population before propensity score matching. (D) Kaplan Meier Curve for NACE after propensity score matching.
Figure 3
Figure 3
Kaplan Meier Curve for major adverse cardiovascular events (MACE) and Net Adverse Clinical Events (NACE) between the different treatment strategies; conservative treatment, only coronary angiography (CAG) or revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). (A) Kaplan Meier Curve for MACE in the total population before propensity score matching. (B) Kaplan Meier Curve for MACE after propensity score matching. (C) Kaplan Meier Curve for NACE in the total population before propensity score matching. (D) Kaplan Meier Curve for NACE after propensity score matching.
See this image and copyright information in PMC

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