(HealthDay News) — Invasive management is beneficial for patients with non-ST elevation myocardial infarction (NSTEMI) aged 80 years or older, according to a study published online in The Lancet.
Amit Kaura, MBChB, from Imperial College London, and colleagues estimated the effectiveness of invasive versus noninvasive management within 3 days of peak troponin concentration on survival for patients aged 80 years and older with NSTEMI. Data were obtained for 1976 patients with NSTEMI from 5 collaborating hospitals in the United Kingdom; 101 died within 3 days of their peak troponin concentration and 375 were excluded with extreme propensity scores, leaving 1500 patients in the analysis.
The researchers found that 56% of the patients received noninvasive management. Overall, 41% of patients died during a median follow-up of 3.0 years. The adjusted cumulative 5-year mortality was 36 and 55% in the invasive management and noninvasive management groups, respectively (adjusted hazard ratio, 0.68). A lower incidence of hospital admission for heart failure was seen in association with invasive management compared with noninvasive management (adjusted rate ratio, 0.67).
“The gold standard is to base treatment decisions on evidence from randomized [controlled] trials, but that doesn’t yet exist for this group of patients,” Kaura said in a statement. “In the interim, we’ve done the next best thing, by looking at retrospective data gathered from these 5 large hospitals and using it like a clinical trial. The results are clear: Clinicians should positively consider invasive management for any patients over 80 diagnosed with an NSTEMI.”
Kaura A, Sterne JAC, Trickey A, et al. Invasive versus non-invasive management of older patients with non-ST elevation myocardial infarction (SENIOR-NSTEMI): a cohort study based on routine clinical data. Published online August 29, 2020. Lancet. doi:10.1016/S0140-6736(20)30930-2