Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non–ST-Segment Elevation Acute Myocardial Infarction: A Randomized Clinical Trial
Primary result · DAOH from discharge to 1 yearResult — go to the resultDifference 28 days 95% CI −7 to 62- prematurely stopped (COVID-19 pandemic)
Authors' conclusion
In this randomized clinical trial of NSTEMI in frail older patients, there was no benefit to a routine invasive strategy in DAOH during the first year.
Study context
- Population
- Frail (Clinical Frailty Scale ≥4) older adults (≥70 years) with NSTEMImean age 86 years
- Participants
- 167 participants
- Comparison
- Routine invasive vs conservative strategy
- Invasiven = 84
- Conservativen = 83reference
- Primary endpoint
- Days alive and out of hospital (days alive and out of the hospital (DAOH)) from discharge; coprimary: cardiac death, reinfarction or postdischarge revascularization
- Follow-up
- 1 year
Methodological detailsmulticentre, 13 Spanish hospitals
- Multicentre
- 13 Spanish hospitals
Primary result
DAOH from discharge to 1 year
Difference
28 days
95% CI −7 to 62
P = 0.12
By group
Conservativevs Invasive
difference 28 days (95% CI −7 to 62); P = 0.12
As reported in the abstract
- Coprimary end point (cardiac death, reinfarction or postdischarge revascularization): no difference, subdistribution HR
- 0.92 (95% CI, 0.54-1.57; P = .78)
Further findings
| Outcome | Difference (days) (95% CI) |
|---|---|
| Survival (restricted mean survival time)Shorter survival with invasive | 28 (−63 to 7) |
All-cause mortality
- No difference in all-cause mortality, HR
- 1.45 (95% CI, 0.74-2.85; P = .28)
Readmissions and days in hospital after discharge
- Readmissions for noncardiac reasons
- 56%
- No differences between groups
Original publication
Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non–ST-Segment Elevation Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA Intern Med. Published 1 May 2023. doi:10.
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