Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/30676
Title: Invasive versus conservative management in patients aged ≥85 years presenting with non-ST-elevation myocardial infarction.
Austin Authors: Kunniardy, Phelia ;Koshy, Anoop N ;Meehan, Georgie;Murphy, Alexandra C ;Ramchand, Jay ;Clark, David J ;Farouque, Omar ;Yudi, Matias B 
Affiliation: Cardiology
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic Miller Family Heart and Vascular Institute, Cleveland, Ohio, USA..
Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia..
Issue Date: Jul-2022
metadata.dc.date: 2022
Publication information: Internal medicine journal 2022; 52(7): 1167-1173
Abstract: Guidelines recommend early coronary angiography (CA) in patients with non-ST-elevation myocardial infarction (NSTEMI) irrespective of age. However, elderly patients are less likely to be treated according to these guidelines due to their perceived high risk and medical comorbidities. Whether an invasive strategy is associated with improved survival in patients aged ≥85 years remains uncertain due to their exclusion from randomised trials. Patients were stratified based on whether they underwent invasive management with CA with a view to revascularisation versus conservative management. The primary outcome was long-term mortality. Consecutive patients aged ≥85 years presenting to a tertiary centre with NSTEMI between 2008 and 2018 were included in this retrospective cohort study. Of 7591 patients with NSTEMI, 1052 patients aged ≥85 years were included. Ninety-nine (9.4%) patients underwent CA. Those undergoing CA were more likely to be younger, male, live independently, without mobility or cognitive issues (all P < 0.01). Overall, 495 (47%) patients died during a mean follow up of 1.3 ± 1 year. On Cox regression, after adjusting for age, pre-morbid functional status, cognition and cardiovascular risk factors, invasive management was the strongest predictor for survival (hazard ratio 0.47; 95% confidence interval 0.26-0.85; P = 0.01). Invasive management was associated with a trend to increased risk of in-hospital bleeding (6.1% vs 2.6%; P = 0.054) with no significant difference in stroke (2.0% vs 3.8%; P = 0.37). In patients aged ≥85 years who presented with NSTEMI, invasive management was associated with improved survival without significant differences in bleeding or stroke. A randomised controlled study assessing the efficacy and safety of invasive management in very elderly patients with NSTEMI is warranted.
URI: https://ahro.austin.org.au/austinjspui/handle/1/30676
DOI: 10.1111/imj.15258
ORCID: 0000-0002-3297-311X
0000-0002-8741-8631
0000-0002-4248-7537
0000-0002-1365-7461
0000-0001-8591-1986
0000-0003-2821-1451
0000-0002-3706-4150
PubMed URL: 33647172
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/33647172/
Type: Journal Article
Subjects: conservative management
elderly
invasive management
non-ST-elevation myocardial infarction
Appears in Collections:Journal articles

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