Comparing health outcomes between coronary interventions in frail patients aged 75 years or older with acute coronary syndrome: a systematic review

Abstract

Purpose To assess current evidence comparing the impact of available coronary interventions in frail patients aged 75 years or older with different subtypes of acute coronary syndrome (ACS) on health outcomes. Methods Scopus, Embase and PubMed were systematically searched in May 2022 for studies comparing outcomes between coronary interventions in frail older patients with ACS. Studies were excluded if they provided no objective assessment of frailty during the index admission, under-represented patients aged 75 years or older, or included patients with non-ACS coronary disease without presenting results for the ACS subgroup. Following data extraction from the included studies, a qualitative synthesis of results was undertaken. Results Nine studies met all eligibility criteria. All eligible studies were observational. Substantial heterogeneity was observed across study designs regarding ACS subtypes included, frailty assessments used, coronary interventions compared, and outcomes studied. All studies were assessed to be at high risk of bias. Notably, adjustment for confounders was limited or not adequately reported in all studies. The comparative assessment suggested a possible efficacy signal for invasive treatment relative to conservative treatment but possibly at the risk of increased bleeding events. Conclusions There is a paucity of evidence comparing health outcomes between different coronary interventions in frail patients aged 75 years or older with ACS. Available evidence is at high risk of bias. Given the growing importance of ACS in frail patients aged 75 years or older, new studies are needed to inform optimal ACS care for this population. Future studies should rigorously adjust for confounders.

Emergency coronary angiography in a 90-plus population – outcomes at 5-year follow-up

“…However, the authors found a dilution of the efficacy of invasive strategy with increasing age and questioned its value to patients older than 90 years [9].. Recently, Wyk et al published a review from trials since January 1990 to May 2022 that compared clinical outcomes in frail patients with 75 years or older submitted to different coronary interventions; results tend to support invasive treatment, but data was not very robust and with high risk of bias [5].…”

“…Elderly people represent a vulnerable and increasing population presenting with acute coronary syndrome (ACS), and even though advancing age is associated with poor outcomes, these patients tend to receive less evidence-based treatments including coronary angiography [2,3]. Traditionally, older patients were underrepresented in ACS trials [4] and, despite new contemporary trials, there is still a paucity of evidence comparing health outcomes [5].…”