Early Invasive or Conservative Strategies for Older Patients With Acute Coronary Syndromes: A Meta-Analysis
An erratum to this article was published (JAMA Intern Med, 1 Aug 2025 ↗)
Pooled result · All-cause deathResult — go to the resultRelative risk 1.05 95% CI 0.98–1.11Authors' conclusion
The results of this systematic review and meta-analysis suggest that, in older patients with ACS, an early invasive strategy was not associated with reduced all-cause death compared with conservative management. An early invasive strategy was associated with reduced recurrent MI and repeated coronary revascularization during follow-up but increased risk of major bleeding. Competing risks associated with an early invasive strategy should be weighed in shared therapeutic decision-making for older patients with ACS.
Study context
- Population
- Patients 70 years or older who presented with acute coronary syndrome (ACS), randomly allocated to early invasive or conservative management
- Comparison
- Early invasive strategy vs a conservative strategy
- Outcome
- All-cause death
Methodological detailsfixed-effects and random-effects modeling
- Fixed-effects and random-effects modeling
Pooled result
As reported in the abstract
Relative risk
1.05
95% CI 0.98–1.11
P = 0.15
Further pooled results
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Recurrent MII 2 = 0%; reduced risk of 22% | 0.78 (0.67–0.91) | P = 0.001 | |
| Repeated coronary revascularization during follow-upI 2 = 33.3%; reduced risk of 57% | 0.43 (0.30–0.60) | P < 0.001 | |
| 0.20.5125Relative risk (log scale) |
Participant characteristics
- Sample size-weighted mean age
- 82.6 years
- Female
- 46%
Other secondary end points
- No differences were observed in secondary end points
Non-ST-elevation ACS population
- Results consistent with the overall findings
Safety
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Major bleedingI 2 = 16.7; increased risk | 1.60 (1.01–2.53) | P = 0.046 | |
| 0.20.5125Relative risk (log scale) |
Original publication
Composed by AI from the published abstract and checked against it. How Briefs are made →