BACKGROUND: It is unclear whether the benefits of an early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) equally apply to younger and older individuals. Elderly patients are generally less likely to undergo EIS when compared with younger patients. OBJECTIVES: We conducted a meta-analysis to compare the benefit of an EIS versus a selectively invasive strategy (SIS) in patients with NSTEACS. We tested the hypothesis that the magnitude of benefit of an EIS over a SIS mainly applies to older individuals. METHODS: We extracted data from randomized controlled trials (RCTs) identified through search methodology filters. The primary outcome of the analysis was the composite of all-cause death and myocardial infarction (MI). Secondary outcomes were death and MI taken alone and re-hospitalization. RESULTS: Nine trials (n = 9,400 patients) were eligible. The incidence of the composite end-point of MI and all-cause death was 16.0% with the EIS and 18.3% with the SIS (OR: 0.85, 95% CI: 0.76-0.95). The incidence of MI was 8.4% with the EIS and 10.9% with the SIS (OR: 0.75, 95% CI: 0.66-0.87). Similar results were obtained for rehospitalization (OR: 0.71, 95% CI: 0.55-0.90). The incidence of all-cause death did not differ between the two groups. The EIS reduced the composite end-point and re-hospitalization to a greater extent in elderly than in younger patients (P for interaction = 0.044 and <0.0001, respectively). These findings were confirmed in meta-regression analyses. CONCLUSIONS: In patients with NSTEACS, a routine EIS reduces the risk of rehospitalization and the composite end point of recurrent MI and death to a greater extent in elderly than in younger individuals.
BACKGROUND: It is unclear whether the benefits of an early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) equally apply to younger and older individuals. Elderly patients are generally less likely to undergo EIS when compared with younger patients. OBJECTIVES: We conducted a meta-analysis to compare the benefit of an EIS versus a selectively invasive strategy (SIS) in patients with NSTEACS. We tested the hypothesis that the magnitude of benefit of an EIS over a SIS mainly applies to older individuals. METHODS: We extracted data from randomized controlled trials (RCTs) identified through search methodology filters. The primary outcome of the analysis was the composite of all-cause death and myocardial infarction (MI). Secondary outcomes were death and MI taken alone and re-hospitalization. RESULTS: Nine trials (n = 9,400 patients) were eligible. The incidence of the composite end-point of MI and all-cause death was 16.0% with the EIS and 18.3% with the SIS (OR: 0.85, 95% CI: 0.76-0.95). The incidence of MI was 8.4% with the EIS and 10.9% with the SIS (OR: 0.75, 95% CI: 0.66-0.87). Similar results were obtained for rehospitalization (OR: 0.71, 95% CI: 0.55-0.90). The incidence of all-cause death did not differ between the two groups. The EIS reduced the composite end-point and re-hospitalization to a greater extent in elderly than in younger patients (P for interaction = 0.044 and <0.0001, respectively). These findings were confirmed in meta-regression analyses. CONCLUSIONS: In patients with NSTEACS, a routine EIS reduces the risk of rehospitalization and the composite end point of recurrent MI and death to a greater extent in elderly than in younger individuals.
Authors: Leonardo De Luca; Zoran Olivari; Leonardo Bolognese; Donata Lucci; Lucio Gonzini; Antonio Di Chiara; Gianni Casella; Francesco Chiarella; Alessandro Boccanelli; Giuseppe Di Pasquale; Francesco M Bovenzi; Stefano Savonitto Journal: Open Heart Date: 2014-12-13
Authors: Daniel Fernández-Bergés; Irene R Degano; Reyes Gonzalez Fernandez; Isaac Subirana; Joan Vila; Manuel Jiménez-Navarro; Silvia Perez-Fernandez; Mercé Roqué; Antoni Bayes-Genis; Francisco Fernandez-Aviles; Antonio Mayorga; Vicente Bertomeu-Gonzalez; Juan Sanchis; Marcos Rodríguez Esteban; Antonio Sanchez-Hidalgo; Esther Sanchez-Insa; Ane Elorriaga; Emad Abu Assi; Alberto Nuñez; Jose Manuel Garcia Ruiz; Pedro Morrondo Valdeolmillos; Daniel Bosch-Portell; Iñaki Lekuona; Andres Carrillo-Lopez; Alberto Zamora; Berta Vega-Hernandez; Javier Alameda Serrano; Catalina Rubert; Luis Ruiz-Valdepeñas; Laura Quintas; Luis Rodríguez-Padial; Jessica Vaquero; Luis Martinez Dolz; Jose A Barrabes; Pedro L Sanchez; Alessandro Sionis; Julio Martí-Almor; Roberto Elosua; Rosa-María Lidon; David Garcia-Dorado; Jaume Marrugat Journal: Open Heart Date: 2020-08