【論文摘要】A Meta-analysis on the Effectiveness of Invasive Strategy versus Conservative Management in Elderly Patients with Non-ST Elevation Acute Coronary Syndrome

Joan Dymphna Reano ； Julie Ann Stephanie Miralles-Amora ； Karen MIralles ； Maria Grethel Dimalala

《海峽循環醫學雜誌》 1卷2S期 (2019/09) Pp. 71-71

https://doi.org/10.6907/SCJ.201909/SP_1(2).0060

摘要

Background/Synopsis: The elderly population is considered a high risk group wherein more than half the mortality in NSTEACS occur. Among people who died of IHD, 83% were ＞65 years of age. Age is one of the most important predictors of risk in NSTEACS. Each 10-year increase in age resulted in a 75% increase in hospital mortality in ACS patients. Due to conflicting results of studies, lack of specific recommendations from current guidelines, and paucity of data on early invasive strategy versus conservative treatment for NSTEACS in elderly patients, this meta-analysis was conducted to focus on this special population to compare benefits and risks of early invasive therapy versus conservative management. Objectives/Purpose: The primary objective is to determine the effectiveness of invasive compared to conservative treatment in reducing major adverse cardiovascular events among elderly patients with non- ST elevation ACS. The specific objective is to determine the effectiveness of invasive strategy compared to conservative treatment, in 6 months (short-term) to 5 years (long-term), in reducing: death or all-cause mortality, cardiovascular mortality, myocardial infarction, stroke, recurrent angina, and need for revascularization. Methods/Results: Randomized controlled trials with outcomes of death, cardiovascular mortality, myocardial infarction, stroke, recurrent angina, and need for revascularization were searched through PubMed, Cochrane, and Google Scholar database. A total of 4,612 patients were included. Lesser incidence of revascularization favoring invasive (2%) over conservative treatment (8%) was observed with overall risk ratio of 0.31 (95% CI 0.16-0.61, I2 =0%). Lesser incidence of stroke was observed in the invasive (2%) versus conservative group (3%) but not statistically significant. A similar trend was noted for the outcomes of death (RR 0.63, 95% CI 0.55-0.72, I2=84%) and myocardial infarction (RR 0.83, 95% CI 0.69 to 0.98, I2=77%) but with significant heterogeneity. There is no difference between the two interventions in the reduction of cardiovascular mortality (RR 1, 95% CI 0.74-1.34, I2=0%). Conclusion: Invasive strategy significantly reduced need for revascularization. A trend towards benefit favoring invasive strategy was also seen in the reduction of death and myocardial infarction but with significant heterogeneity. Further studies focusing on the elderly with larger population size are recommended.