Conservative versus Invasive Strategy in Elderly Patients with Non-ST-Elevation Myocardial Infarction: Insights from the International POPular Age Registry.

Autor: van den Broek WWA; Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands., Gimbel ME; Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands., Chan Pin Yin DRPP; Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands., Azzahhafi J; Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands., Hermanides RS; Department of Cardiology, Isala Hospital, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands., Runnett C; Department of Cardiology, Northumbria Healthcare NHS Foundation Trust, 8 Silver Fox Way, Newcastle upon Tyne NE27 0QJ, UK., Storey RF; Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield S10 2TN, UK., Austin D; Academic Cardiovascular Unit, The James Cook University Hospital, Marton Rd., Middlesbrough TS4 3BW, UK., Oemrawsingh R; Department of Cardiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT Dordrecht, The Netherlands., Cooke J; Department of Cardiology, Chesterfield Royal Hospital NHS Foundation Trust, Chesterfield Rd., Calow, Chesterfield S44 5BL, UK., Galasko G; Department of Cardiology, Blackpool Teaching Hospital NHS Foundation Trust, Whinney Heys Rd., Blackpool FY3 8NR, UK., Walhout RJ; Department of Cardiology, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP Ede, The Netherlands., Schellings DAAM; Department of Cardiology, Slingeland Hospital, Kruisbergseweg 25, 7009 BL Doetinchem, The Netherlands., Brinckman SL; Department of Cardiology, Tergooi MC, Rijksstraatweg 1, 1261 AN Blaricum, The Netherlands., The HK; Department of Cardiology, Treant Zorggroep, Boermarkeweg 60, 7824 AA Emmen, The Netherlands., Stoel MG; Department of Cardiology, Medisch Spectrum Twente, Koningstraat 1, 7512 KZ Enschede, The Netherlands., Heestermans AACM; Department of Cardiology, Noordwest Hospital Group, Wilhelminalaan 12, 1815 JD Alkmaar, The Netherlands., Nicastia D; Department of Cardiology, Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ Apeldoorn, The Netherlands., Emans ME; Department of Cardiology, Ikazia Hospital, Montessoriweg 1, 3083 AN Rotterdam, The Netherlands., van 't Hof AWJ; Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands.; Department of Cardiology, Zuyderland Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands., Alber H; Department for Internal Medicine and Cardiology, KABEG Klinikum, Feschnigstraße 11, 9020 Klagenfurt am Wörthersee, Austria., Gerber R; Department of Cardiology, East Sussex Healthcare NHS Foundation Trust, Dane Rd., Seaford BN25 1DH, UK., van Bergen PFMM; Department of Cardiology, Dijklander Hospital, Maelsonstraat 3, 1624 NP Hoorn, The Netherlands., Aksoy I; Department of Cardiology, Admiraal de Ruyter Hospital, 's-Gravenpolderseweg 114, 4462 RA Goes, The Netherlands., Nasser A; Department of Cardiology, South Tyneside and Sunderland NHS Foundation Trust, Harton Ln., South Shields NE34 0PL, UK., Knaapen P; Department of Cardiology, Amsterdam University Medical Centre, De Boelelaan 1117, 1081 HV Amsterdam, The Netherlands., Botman CJ; Department of Cardiology, Sint Jans Gasthuis, Vogelsbleek 5, 6001 BE Weert, The Netherlands., Liem A; Department of Cardiology, Franciscus Gasthuis, Kleiweg 500, 3045 PM Rotterdam, The Netherlands., Kelder JC; Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands., Ten Berg JM; Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands.; Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2023 Aug 22; Vol. 12 (17). Date of Electronic Publication: 2023 Aug 22.
DOI: 10.3390/jcm12175450
Abstrakt: 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%, adj HR 0.53, 95% CI 0.37-0.77, p = 0.001), remaining significant in the PSM cohort (18% vs. 12%, adj HR 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.
Databáze: MEDLINE
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