Skip to main content
Journal cover image

Routine Invasive Versus Selective Invasive Strategy in Elderly Patients Older Than 75 Years With Non-ST-Segment Elevation Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.

Publication ,  Journal Article
Garg, A; Garg, L; Agarwal, M; Rout, A; Raheja, H; Agrawal, S; Rao, SV; Cohen, M
Published in: Mayo Clin Proc
April 2018

OBJECTIVE: To evaluate outcomes of routine invasive strategy (RIS) compared with selective invasive strategy (SIS) in elderly patients older than 75 years with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). METHODS: We systematically searched databases for randomized controlled trials (RCTs) between January 1, 1990, and October 1, 2016, comparing RIS with SIS for elderly patients (age>75 years) with NSTE-ACS. Random effects meta-analysis was conducted to estimate odds ratio (OR) with 95% CIs for composite of death or myocardial infarction (MI), and individual end points of all-cause death, cardiovascular (CV) death, MI, revascularization, and major bleeding. RESULTS: A total of 6 RCTs with 1887 patients were included in the final analysis. Compared with an SIS, RIS was associated with significantly decreased risk of the composite end point of death or MI (OR, 0.65; 95% CI, 0.51-0.83). Similarly, RIS led to a significant reduction in the risk of MI (OR, 0.51; 95% CI, 0.40-0.66) and need for revascularization (OR, 0.31; 95% CI, 0.11-0.91) compared with SIS. There were no significant differences between RIS and SIS in terms of all-cause death (OR, 0.85; 95% CI, 0.63-1.20), CV death (OR, 0.84; 95% CI, 0.61-1.15), and major bleeding (OR, 1.96; 95% CI, 0.97-3.97). CONCLUSION: In elderly patients older than 75 years with NSTE-ACS, RIS is superior to SIS for the composite end point (death or MI), primarily driven by reduced risk of MI.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Mayo Clin Proc

DOI

EISSN

1942-5546

Publication Date

April 2018

Volume

93

Issue

4

Start / End Page

436 / 444

Location

England

Related Subject Headings

  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Myocardial Revascularization
  • Myocardial Infarction
  • Male
  • Humans
  • Female
  • Coronary Angiography
  • Conservative Treatment
  • Aged, 80 and over
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Garg, A., Garg, L., Agarwal, M., Rout, A., Raheja, H., Agrawal, S., … Cohen, M. (2018). Routine Invasive Versus Selective Invasive Strategy in Elderly Patients Older Than 75 Years With Non-ST-Segment Elevation Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. Mayo Clin Proc, 93(4), 436–444. https://doi.org/10.1016/j.mayocp.2017.11.022
Garg, Aakash, Lohit Garg, Manyoo Agarwal, Amit Rout, Hitesh Raheja, Sahil Agrawal, Sunil V. Rao, and Marc Cohen. “Routine Invasive Versus Selective Invasive Strategy in Elderly Patients Older Than 75 Years With Non-ST-Segment Elevation Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.Mayo Clin Proc 93, no. 4 (April 2018): 436–44. https://doi.org/10.1016/j.mayocp.2017.11.022.
Garg, Aakash, et al. “Routine Invasive Versus Selective Invasive Strategy in Elderly Patients Older Than 75 Years With Non-ST-Segment Elevation Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.Mayo Clin Proc, vol. 93, no. 4, Apr. 2018, pp. 436–44. Pubmed, doi:10.1016/j.mayocp.2017.11.022.
Journal cover image

Published In

Mayo Clin Proc

DOI

EISSN

1942-5546

Publication Date

April 2018

Volume

93

Issue

4

Start / End Page

436 / 444

Location

England

Related Subject Headings

  • Risk Factors
  • Randomized Controlled Trials as Topic
  • Myocardial Revascularization
  • Myocardial Infarction
  • Male
  • Humans
  • Female
  • Coronary Angiography
  • Conservative Treatment
  • Aged, 80 and over