Updated evidence on selection and implementation of an invasive treatment strategy for older patients with non-ST-segment elevation myocardial infarction.

IF 5.1 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
Heart Pub Date : 2025-05-23 DOI:10.1136/heartjnl-2024-325157
Kieran Gill, Vijay Kunadian
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引用次数: 0

Abstract

Non-ST-segment elevation myocardial infarction (NSTEMI) is the most common acute coronary syndrome diagnosis in older patients. In the UK, there are ~20 000 NSTEMI cases annually in patients aged ≥75 years. Despite therapeutic advances in pharmacological and invasive management, studies show that older patients with NSTEMI experience worse in-hospital and long-term outcomes than younger patients, suggesting a clear need for robust evidence in this cohort.The European Society of Cardiology guidelines recommend that invasive management should be considered holistically with no specified age cut-offs. However, older patients are less likely to receive invasive management due to a paucity of evidence from trials that represent contemporary clinical characteristics of older adults. Recruiting older patients realistic of those encountered in clinical practice is hugely challenging. Chronological age alone does not reflect the heterogeneity of the older population; ~30% of older patients with NSTEMI are frail, ~65% are cognitively impaired and most live with at least two additional comorbidities that can influence risk. Weighing the risk of an NSTEMI in an older adult against competing risks attributable to underlying frailty, comorbidities and cognitive impairment poses a key challenge.Recently, the SENIOR-RITA trial showed that invasive management in older patients with NSTEMI is safe and reduces non-fatal myocardial infarction and subsequent revascularisation but does not improve mortality. Individualised risk assessment and shared decision-making is necessary to guide these nuanced decisions. This review discusses the latest evidence regarding invasive management in the older population with NSTEMI, including the impact of geriatric syndromes on clinical outcomes.

老年非st段抬高型心肌梗死患者有创治疗策略的选择和实施的最新证据。
非st段抬高型心肌梗死(NSTEMI)是老年患者最常见的急性冠状动脉综合征诊断。在英国,年龄≥75岁的患者中每年约有20,000例NSTEMI病例。尽管在药理学和侵入性治疗方面取得了进展,但研究表明,老年NSTEMI患者的住院和长期预后比年轻患者更差,这表明在该队列中明确需要强有力的证据。欧洲心脏病学会指南建议,应全面考虑侵入性治疗,没有特定的年龄限制。然而,由于缺乏代表老年人当代临床特征的试验证据,老年患者不太可能接受侵入性治疗。招募临床实践中遇到的老年患者是非常具有挑战性的。单独的实足年龄不能反映老年人口的异质性;~30%的老年NSTEMI患者体弱,~65%的患者认知功能受损,大多数患者至少伴有两种可能影响风险的合并症。权衡老年人NSTEMI的风险与潜在虚弱、合并症和认知障碍的竞争风险是一个关键的挑战。最近,SENIOR-RITA试验表明,对老年非stemi患者进行侵入性治疗是安全的,可以减少非致死性心肌梗死和随后的血运重建,但不能提高死亡率。个性化的风险评估和共同决策对于指导这些细微的决策是必要的。这篇综述讨论了有关老年NSTEMI患者侵入性治疗的最新证据,包括老年综合征对临床结果的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Heart
Heart 医学-心血管系统
CiteScore
10.30
自引率
5.30%
发文量
320
审稿时长
3-6 weeks
期刊介绍: Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.
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