The following is the summary of “Meta-Analysis on Invasive Versus Conservative Strategy in Patients Older Than Seventy Years With Non-ST Elevation Myocardial Infarction” published in the January 2023 issue of Cardiovascular Disease by Khalil, et al.

Progress has been in treating non-ST elevation myocardial infarction (NSTEMI). However, most of the research conducted thus far has been on younger patients. There needs to be more information regarding the treatment of NSTEMI in older adults. Researchers conducted a meta-analysis of randomized controlled trials to determine whether invasive or conservative therapies fare better in the long run for patients older than 70 years old who have NSTEMI. Following a search of 1,550 publications, researchers found 4 randomized controlled trials (1,126 patients) to analyze. 

The median duration of follow-up was 1.25 years (1 to 2.5 years). Patients’ median ages were 83.6 years old (interquartile range: 2.8 years). The risk of major adverse cardiac and cerebrovascular events was considerably reduced with the invasive method (odds ratio [OR] 0.60, 95% confidence interval [CI] 0.40 to 0.91, I² = 54%; 3 trials) and with unplanned revascularization (OR 0.31, 95% CI 0.15 to 0.64, I² = 1.7%; 3 trials). All-cause mortality (OR 0.88, 95% CI 0.65 to 1.18, I² = 0%; 4 trials), myocardial infarction (OR 0.70, 95% CI 0.42 to 1.19, I² = 54.7%; 4 trials), and bleeding (OR 0.87, 95% CI 0.39 to 1.93, I² = 0%; 3 trials) were similar across the 2 approaches. 

Compared with initial conservative treatment, the initial invasive method in older patients presenting with NSTEMI was linked with a considerably lower risk of major adverse cardiac and cerebrovascular events and unexpected revascularization without increased bleeding.

Source: sciencedirect.com/science/article/abs/pii/S0002914922010736