학술논문
Conservative versus Invasive Strategy in Elderly Patients with Non-ST-Elevation Myocardial Infarction: Insights from the International POPular Age Registry.
Document Type
Article
Author
van den Broek, Wout W. A.; Gimbel, Marieke E.; Chan Pin Yin, Dean R. P. P.; Azzahhafi, Jaouad; Hermanides, Renicus S.; Runnett, Craig; Storey, Robert F.; Austin, David; Oemrawsingh, Rohit; Cooke, Justin; Galasko, Gavin; Walhout, Ronald J.; Schellings, Dirk A. A. M.; Brinckman, Stijn L.; The, Hong Kie; Stoel, Martin G.; Heestermans, Antonius A. C. M.; Nicastia, Debby; Emans, Mireille E.; van 't Hof, Arnoud W. J.
Source
Subject
*NON-ST elevated myocardial infarction
*OLDER patients
*ACUTE coronary syndrome
*PROPENSITY score matching
*CONSERVATIVES
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Language
ISSN
2077-0383
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. [ABSTRACT FROM AUTHOR]