Invasive versus conservative strategy after acute coronary syndrome in the elderly > 75 ans: Which strategy for which patient

Abstract

Introduction

Elderly patients represent a special entity in the management of acute coronary syndrome (ACS), given the fragility of this population.

Objective

We analyzed the invasive versus conservative revascularization strategy in patients admitted for ACS over 75 years.

Method

We analyzed in the prospective analysis the invasive versus conservative revascularization strategy in patients admitted for ACS over 75 years to our CICU over a 3-year. The principal endpoint of our study is a composite of all-cause mortality, or readmissions for ACS or acute heart failure (AHF) during follow-up at 1-year.

Results

We included 414 patients who met the inclusion criteria: 173 (41.8%) in the invasive group and 241 (58.2%) in the conservative group, with 66.6% of patients admitted for STEMI. Men represented 63.8%. The invasive strategy group was younger (77.44 vs. 79.93 p < 0.001), with no difference for arterial hypertension (32.9% vs. 21.3%: p = 0.273) or diabetes (25.1% vs. 17.1%: p = 0.688), nor for admission time since onset of pain (11.88 vs. 17.93 p = 0.056), and higher ejection fraction (46.28 vs. 42.66 p = 0.002). For the primary endpoint, 50 (12.1%) were observed with 11 (6.4%) in the invasive group versus 38 (15.8%) in the conservative group (p = 0.003). In the multivariate Cox proportional regression analysis, the invasive strategy was independently associated with a reduction in the principal endpoint at 1-year in all ACS population (HR at 0.483, 95% CI (0.240; 0.975), p = 0.042), but in the subgroup analysis, this reduction is significant only for patients with STEMI (HR at 0.366, 95% CI (0.172; 0.778), p = 0.009) (Fig. 1A). However in patients with NSTEMI, the invasive strategy does not reduce the principal endpoint (HR at 0.370, 95% CI (0.820; 1,668), p = 0.168) (Fig. 1B).

Conclusion

If PCI remains effective in older STEMI patients, then for NSTEMI patients, further clinical trials will be required to fully assess its efficacy.