The following is a summary of “Invasive and conservative management of elderly patients presenting with acute coronary syndrome: A meta-analysis of randomized controlled trials and adjusted observational studies,” published in the September 2024 issue of Cardiology by Improta et al.

Researchers conducted a retrospective study comparing outcomes between initial invasive and conservative strategies in elderly patients with acute coronary syndromes (ACS), who are often under-represented and undertreated.

They followed PRISMA guidelines and RCTs and adjusted observational studies comparing invasive and conservative strategies in elderly patients with ACS. Random or fixed effect models were used; short-term mortality was the primary outcome, and secondary endpoints included re-infarction, MACE, and all-cause mortality. Sensitivity analyses focused on RCTs for primary and 1-year mortality, and short-term mortality was stratified by NSTEMI and STEMI.

The results showed invasive management was associated with lower short and long-term mortality (30 days OR 0.64, 95% CI 0.54–0.76, P<0.001; 1 year HR 0.60, 95% CI 0.52–0.78, P<0.001; Long-term HR 0.62, 95% CI 0.55–0.71, P<0.001) compared to a conservative strategy. In the short-term follow-up, the benefit was preserved when differentiating for NSTEMI or STEMI studies but not when considering only RCTs. Significant bleedings were more frequent in the invasive group (30 days OR 1.61, 95% CI 1.39–1.87, P<0.001). The mean length of stay was not notably different between the 2 strategies (mean difference in days 0.14, 95% CI -0.79 to 1.06, P=0.77).

They found that an initial invasive strategy for elderly patients with ACS might lower mortality but increase bleeding risk, and the results were primarily from non-randomized studies.

Source: sciencedirect.com/science/article/pii/S0167527324011458