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. 2023 Nov 21;82(21):2021-2030.
doi: 10.1016/j.jacc.2023.09.809.

Long-Term Outcomes of Invasive vs Conservative Strategies for Older Patients With Non-ST-Segment Elevation Acute Coronary Syndromes

Erlend S Berg  1 , Nicolai K Tegn  2 , Michael Abdelnoor  2 , Kjetil Røysland  3 , Pål Christie Ryalen  3 , Lars Aaberge  2 , Christian Eek  2 , Erik Øie  4 , Vibeke Juliebø  5 , Erik Gjertsen  6 , Anette Hylen Ranhoff  7 , Lars Gullestad  3 , Njord Nordstrand  2 , Bjørn Bendz  8 ; After Eighty Study Investigators
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Free article

Long-Term Outcomes of Invasive vs Conservative Strategies for Older Patients With Non-ST-Segment Elevation Acute Coronary Syndromes

Erlend S Berg et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is a frequent cause of hospital admission in older people, but clinical trials targeting this population are scarce.

Objectives: The After Eighty Study assessed the effect of an invasive vs a conservative treatment strategy in a very old population with NSTE-ACS.

Methods: Between 2010 and 2014, the investigators randomized 457 patients with NSTE-ACS aged ≥80 years (mean age 85 years) to an invasive strategy involving early coronary angiography with immediate evaluation for revascularization and optimal medical therapy or to a conservative strategy (ie, optimal medical therapy). The primary endpoint was a composite of myocardial infarction, need for urgent revascularization, stroke, and death. The long-term outcomes are presented.

Results: After a median follow up of 5.3 years, the invasive strategy was superior to the conservative strategy in the reduction of the primary endpoint (incidence rate ratio: 0.76; 95% CI: 0.63-0.93; P = 0.0057). The invasive strategy demonstrated a significant gain in event-free survival of 276 days (95% CI: 151-400 days; P = 0.0001) at 5 years and 337 days (95% CI: 123-550 days; P = 0.0001) at 10 years. These results were consistent across subgroups of patients with respect to major cardiovascular prognostic factors.

Conclusions: In patients aged ≥80 years with NSTE-ACS, the invasive strategy was superior to the conservative strategy in the reduction of composite events and demonstrated a significant gain in event-free survival. (The After Eighty Study: a randomized controlled trial; NCT01255540).

Keywords: clinical outcomes; geriatric cardiology; invasive treatment strategy; long-term follow-up; non–ST-segment elevation myocardial infarction.

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Conflict of interest statement

Funding Support and Author Disclosures The After Eighty Study is an investigator-initiated study that received funding from the Norwegian Health Association (ExtraStiftelsen) and Inger and John Fredriksen Heart Foundation. Dr Tegn has received grants from the funders. The funders had no role in data collection, analysis, interpretation, writing of the manuscript or the decision to submit the report. All other authors have reported that they have no relationships relevant to the contents of this paper to declare.

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