Routine invasive vs. conservative strategy in elderly patients with non-ST-elevation acute coronary syndrome.

IF 1.8 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Expert Review of Cardiovascular Therapy Pub Date : 2025-07-05 DOI:10.1080/14779072.2025.2528922

Carlos Diaz-Arocutipa, Rafael Salguero, Roberto Martín-Asenjo, Elena Puerto, Juan Pablo Costabel, Adrian V Hernandez, Lourdes Vicent

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Abstract

Introduction: The optimal management of elderly patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) remains uncertain. This systematic review assessed routine invasive versus conservative strategies in this population.

Methods: PubMed, Embase, and Scopus were searched through September 2024 for randomized controlled trials comparing both strategies. The primary outcome was major adverse cardiovascular events (MACE); secondary outcomes included all-cause mortality, cardiovascular mortality, non-cardiovascular mortality, myocardial infarction, revascularization, stroke, and bleeding. Evidence certainty was evaluated using GRADE, and meta-analyses applied random-effects models.

Results: Seven RCTs (n = 2,997; mean age 81-86 years; 49% female) were included. Invasive strategy reduced MACE risk (HR 0.77, 95% CI 0.65-0.92), with consistent point estimate direction across trials. Myocardial infarction (HR 0.70, 95% CI 0.59-0.84) and revascularization (HR 0.45, 95% CI 0.23-0.90) were also significantly reduced. No significant differences were observed for all-cause mortality (HR1.04, 95% CI 0.90-1.19), cardiovascular mortality (HR 1.10, 95% CI 0.86-1.41), stroke (HR 0.78, 95% CI 0.53-1.16), or bleeding (RR1.23, 95% CI 0.90-1.69). Evidence certainty was moderate for most outcomes.

Conclusions: In elderly NSTE-ACS patients, routine invasive strategy reduces cardiovascular events without significantly increasing bleeding, supporting individualized treatment decisions.

Registration: The protocol for this study was registered in the PROSPERO repository (CRD42024600769).

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老年非st段抬高急性冠状动脉综合征患者的常规侵入与保守治疗策略。

背景：老年非st段抬高急性冠脉综合征（NSTE-ACS）患者的最佳治疗方法仍不确定。本系统综述评估了该人群的侵入性与保守性策略。方法：到2024年9月，检索PubMed、Embase和Scopus，比较两种策略的随机对照试验（rct）。主要终点为主要不良心血管事件（MACE）；次要结局包括全因死亡率、心血管死亡率、非心血管死亡率、心肌梗死、血运重建术、中风和出血。证据确定性采用GRADE评估，meta分析采用随机效应模型。结果：7项随机对照试验(n= 2997；平均年龄81 ~ 86岁；49%为女性)。侵入性治疗降低了MACE风险（HR 0.77, 95% CI 0.65-0.92），各试验的点估计方向一致。心肌梗死（HR 0.70, 95% CI 0.59-0.84）和血运重建（HR 0.45, 95% CI 0.23-0.90）也显著减少。全因死亡率（HR 1.04, 95% CI 0.90-1.19）、心血管死亡率（HR 1.10, 95% CI 0.86-1.41）、卒中（HR 0.78, 95% CI 0.53-1.16）或出血（RR 1.23, 95% CI 0.90-1.69）均无显著差异。大多数结果的证据确定性为中等。结论：在老年NSTE-ACS患者中，有创治疗可减少心血管事件而不显著增加出血，支持个体化治疗决策。

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

Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

3.70

自引率

0.00%

发文量

期刊介绍： Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.