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

被引：2

作者：

Van den Broek, Wout W. A. ^{[1
]}

Gimbel, Marieke E. ^{[1
]}

Yin, Dean R. P. P. Chan Pin ^{[1
]}

Azzahhafi, Jaouad ^{[1
]}

Hermanides, Renicus S. ^{[2
]}

Runnett, Craig ^{[3
]}

Storey, Robert F. ^{[4
]}

Austin, David ^{[5
]}

Oemrawsingh, Rohit ^{[6
]}

Cooke, Justin ^{[7
]}

Galasko, Gavin ^{[8
]}

Walhout, Ronald J. ^{[9
]}

Schellings, Dirk A. A. M. ^{[10
]}

Brinckman, Stijn L. ^{[11
]}

The, Hong Kie ^{[12
]}

Stoel, Martin G. ^{[13
]}

Heestermans, Antonius A. C. M. ^{[14
]}

Nicastia, Debby ^{[15
]}

Emans, Mireille E. ^{[16
]}

Van 't Hof, Arnoud W. J. ^{[17
,18
,19
]}

Alber, Hannes ^{[20
]}

Gerber, Robert ^{[21
]}

Van Bergen, Paul F. M. M. ^{[22
]}

Aksoy, Ismail ^{[23
]}

Nasser, Abdul ^{[24
]}

Knaapen, Paul ^{[25
]}

Botman, Cees-Joost ^{[26
]}

Liem, Anho ^{[27
]}

Kelder, Johannes C. ^{[1
]}

ten Berg, Jurrien M. ^{[1
,18
]}

机构：

[1] St Antonius Hosp Nieuwegein, Dept Cardiol, Koekoekslaan 1, NL-3435 CM Nieuwegein, Netherlands

[2] Isala Hosp, Dept Cardiol, Dokter van Heesweg 2, NL-8025 AB Zwolle, Netherlands

[3] Northumbria Healthcare NHS Fdn Trust, Dept Cardiol, 8 Silver Fox Way, Newcastle Upon Tyne NE27 0QJ, England

[4] Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Sheffield S10 2TN, England

[5] James Cook Univ Hosp, Acad Cardiovasc Unit, Marton Rd, Middlesbrough TS4 3BW, England

[6] Albert Schweitzer Hosp, Dept Cardiol, Albert Schweitzerplaats 25, NL-3318 AT Dordrecht, Netherlands

[7] Chesterfield Royal Hosp NHS Fdn Trust, Dept Cardiol, Chesterfield Rd, Chesterfield S44 5BL, England

[8] Blackpool Teaching Hosp NHS Fdn Trust, Dept Cardiol, Whinney Heys Rd, Blackpool FY3 8NR, England

[9] Gelderse Vallei Hosp, Dept Cardiol, Willy Brandtlaan 10, NL-6716 RP Ede, Netherlands

[10] Slingeland Hosp, Dept Cardiol, Kruisbergseweg 25, NL-7009 BL Doetinchem, Netherlands

[11] Tergooi MC, Dept Cardiol, Rijksstraatweg 1, NL-1261 AN Blaricum, Netherlands

[12] Treant Zorggroep, Dept Cardiol, Boermarkeweg 60, NL-7824 AA Emmen, Netherlands

[13] Med Spectrum Twente, Dept Cardiol, Koningstr 1, NL-7512 KZ Enschede, Netherlands

[14] Noordwest Hosp Grp, Dept Cardiol, Wilhelminalaan 12, NL-1815 JD Alkmaar, Netherlands

[15] Gelre Hosp, Dept Cardiol, Albert Schweitzerlaan 31, NL-7334 DZ Apeldoorn, Netherlands

[16] Ikazia Hosp, Dept Cardiol, Montessoriweg 1, NL-3083 AN Rotterdam, Netherlands

[17] Maastricht Univ, Med Ctr, Dept Cardiol, P Debyelaan 25, NL-6229 HX Maastricht, Netherlands

[18] Cardiovasc Res Inst Maastricht, Univ singel 50, NL-6229 ER Maastricht, Netherlands

[19] Zuyderland Med Ctr, Dept Cardiol, Henri Dunantstr 5, NL-6419 PC Heerlen, Netherlands

[20] KABEG Klinikum, Dept Internal Med & Cardiol, Feschnigstr 11, A-9020 Klagenfurt, Austria

[21] East Sussex Healthcare NHS Fdn Trust, Dept Cardiol, Dane Rd, Seaford BN25 1DH, England

[22] Dijklander Hosp, Dept Cardiol, Maelsonstr 3, NL-1624 NP Hoorn, Netherlands

[23] Admiraal Ruyter Hosp, Dept Cardiol, S Gravenpolderseweg 114, NL-4462 RA Goes, Netherlands

[24] South Tyneside & Sunderland NHS Fdn Trust, Dept Cardiol, Harton Ln, South Shields NE34 0PL, England

[25] Amsterdam Univ Med Ctr, Dept Cardiol, Boelelaan 1117, NL-1081 HV Amsterdam, Netherlands

[26] Sint Jans Gasthuis, Dept Cardiol, Vogelsbleek 5, NL-6001 BE Weert, Netherlands

[27] Franciscus Gasthuis, Dept Cardiol, Kleiweg 500, NL-3045 PM Rotterdam, Netherlands

来源：

JOURNAL OF CLINICAL MEDICINE | 2023年 / 12卷 / 17期

关键词：

coronary artery disease; non-ST-elevation myocardial infarction; elderly; conservative strategy; invasive strategy; ACUTE CORONARY SYNDROMES; OPEN-LABEL; OLDER; MANAGEMENT; CLOPIDOGREL; TICAGRELOR; OUTCOMES;

D O I：

10.3390/jcm12175450

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

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 & GE;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.

引用

页数：14

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