Author + information
- Aakash Garg,
- Amit Rout,
- Sahil Agrawal,
- Tanush Gupta,
- Shivank Madan,
- Gautam Visveswaran,
- Lohit Garg,
- Parasuram Krishnamoorthy,
- Abhishek Sharma and
- John Kostis
Background: Current guidelines recommend a routine invasive strategy for patients with non-ST elevation acute coronary syndrome (NSTE-ACS). However, elderly patients with NSTE-ACS are under-represented in randomized controlled trials (RCTs) and less likely receive invasive treatment.
Methods: A systematic review of RCTs in MEDLINE, EMBASE and Cochrane databases comparing routine invasive with conservative strategy for elderly patients (age> 75 years) with NSTE-ACS was performed. The primary end-point was composite of death and myocardial infarction (MI). Random effects meta-analysis was conducted to estimate odds ratio (OR) with 95% confidence intervals for individual end-points.
Results: A total of 6 studies with 1,887 patients were included in the final analysis. Compared to a conservative strategy, routine invasive strategy was associated with significantly decreased risk of the primary composite of death or MI [OR 0.65; 95% 0.51-0.83]. There were no significant differences between conservative and routine invasive strategies in terms of all-cause [0.85; 95% CI 0.63-1.20] or cardiovascular [0.84; 95% CI 0.61-1.15] death. A routine invasive strategy led to significant reduction in risk of MI [OR 0.51; 95% CI 0.40-0.66] and need for revascularization [OR 0.31; 95% CI 0.11-0.91] compared to conservative strategy.
Conclusions: In elderly patients>75 years, routine invasive strategy is superior to conservative strategy for the composite end-point, primarily driven by reduced risk of MI.
Poster Contributions Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Timely Topics in Acute Coronary Syndromes
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1242-164
- 2017 American College of Cardiology Foundation