Long-Term Outcomes of Invasive vs Conservative Strategies for Older Patients With Non–ST-Segment Elevation Acute Coronary Syndromes

医学 急性冠脉综合征 临床终点 心肌梗塞 血运重建 内科学 人口 随机对照试验 冲程(发动机) 心脏病学 入射(几何) 机械工程 物理 环境卫生 光学 工程类
作者
Erlend Sturle Berg,Nicolai Tegn,Michael Abdelnoor,Kjetil Røysland,Pål Christie Ryalen,Lars Aaberge,Christian Eek,Erik Øie,Vibeke Juliebø,Erik Gjertsen,Anette Hylen Ranhoff,Lars Gullestad,Njord Nordstrand,Bjørn Bendz
出处
期刊:Journal of the American College of Cardiology [Elsevier BV]
卷期号:82 (21): 2021-2030 被引量:11
标识
DOI:10.1016/j.jacc.2023.09.809
摘要

Non–ST-segment elevation acute coronary syndrome (NSTE-ACS) is a frequent cause of hospital admission in older people, but clinical trials targeting this population are scarce. The After Eighty Study assessed the effect of an invasive vs a conservative treatment strategy in a very old population with NSTE-ACS. Between 2010 and 2014, the investigators randomized 457 patients with NSTE-ACS aged ≥80 years (mean age 85 years) to an invasive strategy involving early coronary angiography with immediate evaluation for revascularization and optimal medical therapy or to a conservative strategy (ie, optimal medical therapy). The primary endpoint was a composite of myocardial infarction, need for urgent revascularization, stroke, and death. The long-term outcomes are presented. After a median follow up of 5.3 years, the invasive strategy was superior to the conservative strategy in the reduction of the primary endpoint (incidence rate ratio: 0.76; 95% CI: 0.63-0.93; P = 0.0057). The invasive strategy demonstrated a significant gain in event-free survival of 276 days (95% CI: 151-400 days; P = 0.0001) at 5 years and 337 days (95% CI: 123-550 days; P = 0.0001) at 10 years. These results were consistent across subgroups of patients with respect to major cardiovascular prognostic factors. In patients aged ≥80 years with NSTE-ACS, the invasive strategy was superior to the conservative strategy in the reduction of composite events and demonstrated a significant gain in event-free survival. (The After Eighty Study: a randomized controlled trial; NCT01255540)
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