Kristin Marie Kvakkestad1,2,3, Jon Michael Gran4, Jan Eritsland5, Charlotte Holst Hansen5, Eigil Fossum5, Geir Øystein Andersen5, Sigrun Halvorsen5,6. 1. Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway, kristinturcuta@gmail.com. 2. Institute of Clinical Medicine, University of Oslo, Oslo, Norway, kristinturcuta@gmail.com. 3. Department of Medicine, Østfold Hospital, Kalnes, Grålum, Norway, kristinturcuta@gmail.com. 4. Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital and University of Oslo, Oslo, Norway. 5. Department of Cardiology, Oslo University Hospital Ullevål, Oslo, Norway. 6. Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
Abstract
BACKGROUND: The optimal management of elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) is still discussed. We aimed to study short- and long-term survival in NSTEMI patients ≥75 years managed with an invasive or a conservative strategy. METHODS: NSTEMI patients admitted to Oslo University Hospital Ulleval during 2005-2011 were included consecutively in a prospective registry. Vital status until December 31, 2013, was obtained from the Norwegian Cause of Death Registry. Patients ≥75 years were identified, and 30-day and 7-year survival were analyzed. Logistic- and Cox regression was used to estimate OR and hazard ratio (HR) for death in the invasive versus conservative group, adjusting for registered confounders. RESULTS: There were 2,064 NSTEMI patients ≥75 years (48.2% women); 1,200 (58.1%) were treated with an invasive strategy, and were younger, more likely to be male and previously revascularized compared to 864 (41.9%) patients treated conservatively (p < 0.0001 for all). Survival at 30-day was 94.9% in the invasive and 76.6% in the conservative group. For 30-day survivors, 7-year survival was 47.4% (95% CI 42.9-51.8) and 11.6% (95% CI 8.3-15.6), respectively. After multivariate adjustment, an invasive strategy was associated with lower long-term risk (adjusted HR [aHR] 0.49 [95% CI 0.41-0.59]). Actual revascularization was associated with lower risk of long-term mortality compared to angiography only (aHRPCI 0.73 [95% CI 0.59-0.90], aHRCABG 0.43 [95% CI 0.28-0.65]). CONCLUSION: In this real-life cohort of NSTEMI patients ≥75 years, 30-day survival was 95%, and 7-year survival was 47% with an invasive strategy. Revascularized patients had a superior long-term prognosis. With a conservative strategy, short- and long-term survival was lower, probably due to selection bias and unmeasured confounding. The Author(s). Published by S. Karger AG, Basel.
BACKGROUND: The optimal management of elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) is still discussed. We aimed to study short- and long-term survival in NSTEMI patients ≥75 years managed with an invasive or a conservative strategy. METHODS: NSTEMI patients admitted to Oslo University Hospital Ulleval during 2005-2011 were included consecutively in a prospective registry. Vital status until December 31, 2013, was obtained from the Norwegian Cause of Death Registry. Patients ≥75 years were identified, and 30-day and 7-year survival were analyzed. Logistic- and Cox regression was used to estimate OR and hazard ratio (HR) for death in the invasive versus conservative group, adjusting for registered confounders. RESULTS: There were 2,064 NSTEMI patients ≥75 years (48.2% women); 1,200 (58.1%) were treated with an invasive strategy, and were younger, more likely to be male and previously revascularized compared to 864 (41.9%) patients treated conservatively (p < 0.0001 for all). Survival at 30-day was 94.9% in the invasive and 76.6% in the conservative group. For 30-day survivors, 7-year survival was 47.4% (95% CI 42.9-51.8) and 11.6% (95% CI 8.3-15.6), respectively. After multivariate adjustment, an invasive strategy was associated with lower long-term risk (adjusted HR [aHR] 0.49 [95% CI 0.41-0.59]). Actual revascularization was associated with lower risk of long-term mortality compared to angiography only (aHRPCI 0.73 [95% CI 0.59-0.90], aHRCABG 0.43 [95% CI 0.28-0.65]). CONCLUSION: In this real-life cohort of NSTEMI patients ≥75 years, 30-day survival was 95%, and 7-year survival was 47% with an invasive strategy. Revascularized patients had a superior long-term prognosis. With a conservative strategy, short- and long-term survival was lower, probably due to selection bias and unmeasured confounding. The Author(s). Published by S. Karger AG, Basel.
Authors: Alan J Bagnall; Shaun G Goodman; Keith A A Fox; Raymond T Yan; Joel M Gore; Asim N Cheema; Thao Huynh; Denis Chauret; David H Fitchett; Anatoly Langer; Andrew T Yan Journal: Am J Cardiol Date: 2009-04-08 Impact factor: 2.778
Authors: Harvey D White; Cynthia M Westerhout; Karen P Alexander; Matthew T Roe; Kenneth J Winters; Derek D Cyr; Keith Aa Fox; Dorairaj Prabhakaran; Judith S Hochman; Paul W Armstrong; E Magnus Ohman Journal: Eur Heart J Acute Cardiovasc Care Date: 2015-04-20
Authors: L Carnendran; R Abboud; L A Sleeper; R Gurunathan; J G Webb; V Menon; V Dzavik; T Cocke; J S Hochman Journal: Eur Heart J Date: 2001-03 Impact factor: 29.983
Authors: M Moscucci; K A A Fox; Christopher P Cannon; W Klein; José López-Sendón; G Montalescot; K White; R J Goldberg Journal: Eur Heart J Date: 2003-10 Impact factor: 29.983