Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial

Tegn, Nicolai; Abdelnoor, Michael; Aaberge, Lars; Endresen, Knut; Smith, Pål; Aakhus, Svend; Gjertsen, Erik; Dahl-Hofseth, Ola; Ranhoff, Anette Hylen; Gullestad, Lars; Bendz, Bjørn

doi:10.1016/s0140-6736(15)01166-6

Cited by 350 publications

(252 citation statements)

References 27 publications

Supporting

Mentioning

204

Contrasting

Unclassified

Order By: Relevance

“…In our study, the frail population received less cardiac catheterizations and culprit lesion revascularization, DAPT, or statins, even though this group had a higher risk profile. Recent data suggest that an initial invasive strategy can improve outcomes in elderly population with non-STEMI; however, in frail patients the role of the invasive strategy remains unclear [26, 27]. …”

Section: Discussionmentioning

confidence: 99%

The Role of Frailty in Acute Coronary Syndromes in the Elderly

et al. 2018

View full text Add to dashboard Cite

Background: Myocardial infarction (MI) patients are increasingly older, and common risk scores include chronological age, but do not consider chronic comorbidity or biological age. Frailty status reflects these variables and may be independently correlated with prognosis in this setting. Objective: This study investigated the impact of frailty on the prognosis of elderly patients admitted due to MI. Methods: This prospective and observational study included patients ≥75 years admitted to three tertiary hospitals in Spain due to MI. Frailty assessment was performed at admission using the Survey of Health, Ageing and Retirement in Europe Frailty Index (SHARE-FI) tool. The primary endpoint was the composite of death or non-fatal reinfarction during a follow-up of 1 year. Overall mortality, reinfarction, the composite of death, reinfarction and stroke, major bleeding, and readmission rates were also explored. Results: A total of 285 patients were enrolled. Frail patients (109, 38.2%) were older, with a higher score in the Charlson Comorbidity Index and with a higher risk score addressed in the GRACE and CRUSADE indexes. On multivariate analysis including GRACE, CRUSADE, maximum creatinine level, culprit lesion revascularization, complete revascularization, and dual antiplatelet therapy at discharge, frailty was an independent predictor of the composite of death and reinfarction (2.81, 95% CI 1.16–6.78) and overall mortality (3.07, 95% CI 1.35–6.98). Conclusion: Frailty is an independent prognostic marker of the composite of mortality and reinfarction and of overall mortality in patients aged ≥75 years admitted due to MI.

show abstract

Section: Discussionmentioning

confidence: 99%

The Role of Frailty in Acute Coronary Syndromes in the Elderly

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Coronary disease disproportionately affects older adults; however, long‐term outcomes of older patients after myocardial infarction (MI) are not well studied, as these patients are often under‐represented in randomized clinical trials and prospective longitudinal studies rarely follow patients beyond the first few years after their index event 1, 2, 3, 4. Knowledge of long‐term prognosis can aid in treatment decisions for older patients with MI.…”

Section: Introductionmentioning

confidence: 99%

Long‐Term Mortality of Older Patients With Acute Myocardial Infarction Treated in US Clinical Practice

Kochar

Chen

Sharma

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundThere is limited information about the long‐term survival of older patients after myocardial infarction (MI).Methods and Results CRUSADE (Can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the ACC/AHA guidelines) was a registry of MI patients treated at 568 US hospitals from 2001 to 2006. We linked MI patients aged ≥65 years in CRUSADE to their Medicare data to ascertain long‐term mortality (defined as 8 years post index event). Long‐term unadjusted Kaplan–Meier mortality curves were examined among patients stratified by revascularization status. A landmark analysis conditioned on surviving the first year post‐MI was conducted. We used multivariable Cox regression to compare mortality risks between ST‐segment–elevation myocardial infarction and non–ST‐segment–elevation myocardial infarction patients. Among 22 295 MI patients ≥ age 65 years (median age 77 years), we observed high rates of evidence‐based medication use at discharge: aspirin 95%, β‐blockers 94%, and statins 81%. Despite this, mortality rates were high: 24% at 1 year, 51% at 5 years, and 65% at 8 years. Eight‐year mortality remained high among patients who underwent percutaneous coronary intervention (49%), coronary artery bypass graft (46%), and among patients who survived the first year post‐MI (59%). Median survival was 4.8 years (25th, 75th percentiles 1.1, 8.5); among patients aged 65–74 years it was 8.2 years (3.3, 8.9) while for patients aged ≥75 years it was 3.1 years (0.6, 7.6). Eight‐year mortality was lower among ST‐segment–elevation myocardial infarction than non–ST‐segment–elevation myocardial infarction patients (53% versus 67%); this difference was not significant after adjustment (hazard ratio 0.94, 95% confidence interval, 0.88–1.00).ConclusionsLong‐term mortality remains high among patients with MI in routine clinical practice, even among revascularized patients and those who survived the first year.

show abstract

“…One aspect in the very elderly population was investigated by Tegn et al 36 They studied whether patients aged 80 years or older presenting with an ACS without ST-segment elevation would benefit from an early invasive strategy compared to an initially conservative management. During a median follow-up of 1.53 years, the primary outcome, a composite of MI, need for urgent revascularization, stroke, and death, occurred in 93 (40.6%) of 229 patients assigned to the invasive group and 140 (61.4%) of 228 patients assigned to the conservative group (HR 0.53 [95% CI 0.41-0.69], P = 0.0001).…”

Section: Treatment Of the Elderlymentioning

confidence: 99%