Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction

Sanchís, Juan; Núñez, Eduardo; Barrabés, José A.; Marı́n, Francisco; Consuegra-Sánchez, Luciano; Ventura, Silvia Mastrolembo; Valero, Ernesto; Roqué, Mercè; Bayés‐Genís, Antoni; Blanco, Bruno García del; Dégano, Irene R.; Núñez, Julio

doi:10.1016/j.ejim.2016.07.003

Cited by 73 publications

(59 citation statements)

References 25 publications

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“…Despite this, other studies have already showed no differences between MT and pPCI groups in frail older patients with ACS, mainly in non-ST segment elevation myocardial. 26,27 Although these studies did not include patients with STEMI, they emphasize the importance of the functional assessment of older patients. 28 In our results, pPCI was the preferred strategy, when appropriate, in this high-risk cohort to ensure improved physical function and cognition and reduced reliance on medications.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Nonagenarians With ST Elevation Myocardial Infarction

Cepas‐Guillén

Borrego-Rodriguez

Flores‐Umanzor

et al. 2020

The American Journal of Cardiology

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Section: Discussionmentioning

confidence: 99%

Outcomes of Nonagenarians With ST Elevation Myocardial Infarction

Cepas‐Guillén

Borrego-Rodriguez

Flores‐Umanzor

et al. 2020

The American Journal of Cardiology

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“…In the control group all the trials used standard medical treatment [12][13][14][15][16][17]. In the treatment arm, four trials specified the time to intervention (4-72 hours) [12,14,15,16]. One of the six studies defined the time to intervention as coronary angiography and, if appropriate, revascularization within 7 days from admission for the index event [17].…”

Section: Description Of Studiesmentioning

confidence: 99%

“…Only one study did not specify the time to intervention but only mentioned "during initial admission" [13]. All of the trials included CABG as part of the intervention when indicated [12][13][14][15][16][17]. The study by Tegn et al also reported that 860 out of 1,316 (65%) underwent PCI but also just stated that 71% had either PCI or CABG.…”

Section: Description Of Studiesmentioning

confidence: 99%

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A systematic review and meta-analysis on the effectiveness of an invasive strategy compared to a conservative approach in patients > 65 years old with non-ST elevation acute coronary syndrome

et al. 2020

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Background Patients 65 years old and older largely represent (>50%) hospital-admitted patients with acute coronary syndrome (ACS). Data are conflicting comparing efficacy of early routine invasive (within 48-72 hours of initial evaluation) versus conservative management of ACS in this population. Objective We aimed to determine the effectiveness of routine early invasive strategy compared to conservative treatment in reducing major adverse cardiovascular events in patients 65 years old and older with non-ST elevation (NSTE) ACS. Data sources We conducted a systematic review of randomized controlled trials (RCTs) through PubMed, Cochrane, and Google Scholar database. Study selection The studies included were RCTs that evaluated the effectiveness of invasive strategy compared to conservative treatment among patients � 65 years old diagnosed with NSTEACS. Studies were included if they assessed any of the following outcomes of death, cardiovascular mortality, myocardial infarction (MI), stroke, recurrent angina, and need for revascularization. Six articles were subsequently included in the meta-analysis.

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“…Although, a subgroup analysis showed significant benefit from invasive treatment in patients with elevated troponin levels [38]. Also the coMOrbilidades en el Síndrome Coronario Agudo (MOSCA) study found no significant differences between invasive versus conservative treatment in comorbid elderly patients (≥70 years) with non-ST-segment-elevation MI [39]. Both trials were ended prematurely.…”

Section: Step Five: Invasive Managementmentioning

confidence: 99%

Management of elderly patients with a non-ST-segment-elevation acute coronary syndrome

Gimbel

Berg

2017

Neth Heart J

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Elderly patients with an acute coronary syndrome are underrepresented in randomised controlled trials. Neither the European Society of Cardiology nor the American Heart Association/American College of Cardiology acute coronary syndrome guidelines provide specific recommendations for elderly patients. However, elderly patients are at higher thrombotic and bleeding risk compared with younger patients leading to difficulties in choosing the optimal treatment. In this review, we discuss the uncertainties we encounter in treating elderly patients with non-ST-elevation acute coronary syndrome and suggest treatment options based on the existing literature.

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Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction

Cited by 73 publications

References 25 publications

Outcomes of Nonagenarians With ST Elevation Myocardial Infarction

Outcomes of Nonagenarians With ST Elevation Myocardial Infarction

A systematic review and meta-analysis on the effectiveness of an invasive strategy compared to a conservative approach in patients > 65 years old with non-ST elevation acute coronary syndrome

Management of elderly patients with a non-ST-segment-elevation acute coronary syndrome

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