PMID- 35803333
OWN - NLM
STAT- MEDLINE
DCOM- 20220830
LR  - 20220830
IS  - 1535-6280 (Electronic)
IS  - 0146-2806 (Linking)
VI  - 47
IP  - 10
DP  - 2022 Oct
TI  - Routine Invasive Strategy in Elderly Patients with Non-ST Elevation Acute 
      Coronary Syndrome: An Updated Systematic Review and Meta-analysis of Randomized 
      Trials.
PG  - 101304
LID - S0146-2806(22)00201-8 [pii]
LID - 10.1016/j.cpcardiol.2022.101304 [doi]
AB  - Invasive treatment with coronary angiography is preferred approach for patients 
      with non-ST elevation acute coronary syndrome (NSTE-ACS) compared to medical 
      therapy alone. The results from the randomized clinical trials (RCT) that 
      compared the invasive treatment strategy vs. conservative approach in the elderly 
      (>/=75 years) with NSTE-ACS has been inconsistent. To compare invasive and 
      conservative strategies in the elderly (>75 years) with NSTE-ACS. We searched 
      PubMed, Cochrane CENTRAL Register and ClinicalTrials.gov (inception through July 
      10, 2021) for RCTs comparing invasive and conservative strategies in the elderly 
      with NSTE-ACS. We used random-effects model to calculate risk ratio (RR) with 95% 
      confidence interval(CI). A total of 6 RCT including 2,323 patients were included 
      in the meta-analysis. The median follow-up duration was 13.5 months. When 
      invasive approach was compared to conservative strategy, it showed no difference 
      in all-cause mortality in patients aged >/=75 years with NSTE-ACS (RR of 0.85; 95% 
      CI 0.70-1.04; P = 0.12; I2 = 0%). There was significant reduction in MI (RR 0.59; 
      95% CI 0.49 0.71; P < 0.001; I2 = 0%) and unplanned revascularization (RR 0.30, 
      95% CI 0.17-0.53, P <0.001, I2 = 0%). Invasive strategy was associated with 
      higher risk of major bleeding when compared to conservative treatment (RR 2.12, 
      95% CI 1.21-3.74, P = 0.009, I2 = 0%). Comparison of both strategies showed no 
      significant difference in stroke (RR 0.75; 95% CI 0.38-1.46, P = 0.40; I2 = 0%). 
      This updated meta-analysis suggests that in elderly patients (>75 years) with 
      NSTE-ACS, a routine invasive strategy is associated with a reduction in MI and 
      revascularization, while increasing the risk of major bleeding, but without 
      difference in all-cause mortality and stroke.
CI  - Published by Elsevier Inc.
FAU - Abusnina, Waiel
AU  - Abusnina W
AD  - Division of Cardiovascular Diseases, Creighton University School of Medicine, 
      Omaha, NE. Electronic address: dr.abusnina@gmail.com.
FAU - Radaideh, Qais
AU  - Radaideh Q
AD  - Division of Cardiovascular Diseases, Creighton University School of Medicine, 
      Omaha, NE.
FAU - Al-Abdouh, Ahmad
AU  - Al-Abdouh A
AD  - Department of Medicine, University of Kentucky, Lexington, KY.
FAU - Ismayl, Mahmoud
AU  - Ismayl M
AD  - Division of Cardiovascular Diseases, Creighton University School of Medicine, 
      Omaha, NE.
FAU - Algheriani, Hedaia
AU  - Algheriani H
AD  - Department of Medicine, National Heart center, Tajoura, Libya.
FAU - Lee, Juyong
AU  - Lee J
AD  - Division of interventional cardiology, University of Connecticut Health Center, 
      Farmington, CT.
FAU - Alam, Mahboob
AU  - Alam M
AD  - Section of Cardiology, Department of Medicine, Baylor College of Medicine, 
      Houston, TX.
FAU - Ben-Dor, Itsik
AU  - Ben-Dor I
AD  - Section of Interventional Cardiology, MedStar Washington Hospital Center, 
      Washington DC.
FAU - Jimenez, Enrique
AU  - Jimenez E
AD  - Section of Cardiology, Overton Brooks Veterans Affairs Medical Center, 
      Shreveport, LA.
FAU - Azrin, Michael
AU  - Azrin M
AD  - Division of interventional cardiology, University of Connecticut Health Center, 
      Farmington, CT.
FAU - Paul, Timir K
AU  - Paul TK
AD  - Department of medical education, University of Tennessee at Nashville, Nashville, 
      TN.
FAU - Dahal, Khagendra
AU  - Dahal K
AD  - Division of Cardiovascular Diseases, Creighton University School of Medicine, 
      Omaha, NE.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20220705
PL  - Netherlands
TA  - Curr Probl Cardiol
JT  - Current problems in cardiology
JID - 7701802
SB  - IM
MH  - *Acute Coronary Syndrome
MH  - Aged
MH  - Coronary Angiography
MH  - Humans
MH  - Myocardial Revascularization
MH  - Randomized Controlled Trials as Topic
MH  - *Stroke
MH  - Treatment Outcome
EDAT- 2022/07/09 06:00
MHDA- 2022/08/31 06:00
CRDT- 2022/07/08 19:23
PHST- 2022/06/26 00:00 [received]
PHST- 2022/06/28 00:00 [accepted]
PHST- 2022/07/09 06:00 [pubmed]
PHST- 2022/08/31 06:00 [medline]
PHST- 2022/07/08 19:23 [entrez]
AID - S0146-2806(22)00201-8 [pii]
AID - 10.1016/j.cpcardiol.2022.101304 [doi]
PST - ppublish
SO  - Curr Probl Cardiol. 2022 Oct;47(10):101304. doi: 10.1016/j.cpcardiol.2022.101304. 
      Epub 2022 Jul 5.