Coronary disease & ACS

Long-Term Outcomes of Invasive vs Conservative Strategies for Older Patients With Non–ST-Segment Elevation Acute Coronary Syndromes

J Am Coll CardiolPublished Randomised controlled trial

Primary resultResult — go to the resultIncidence rate ratio 0.76 95% CI 0.63–0.93

Authors' conclusion

In patients aged ≥80 years with NSTE-ACS, the invasive strategy was superior to the conservative strategy in the reduction of composite events and demonstrated a significant gain in event-free survival.

Study context

Population
Patients aged ≥80 years with NSTE-ACS (mean age 85 years), randomised 2010–2014
Participants
457 patients
Comparison
Invasive vs conservative strategy
Primary endpoint
Composite of:
  • MI
  • Need for urgent revascularization
  • Stroke
  • Death
Follow-up
Median 5.3 years
Methodological detailslong-term follow-up
  • Long-term follow-up

Primary result

As reported in the abstract

Incidence rate ratio

0.76

95% CI 0.63–0.93

P = 0.0057

Invasive vs Conservative
incidence rate ratio 0.76 (95% CI 0.63–0.93); P = 0.0057

Further findings

OutcomeGain in event-free survival (days) (95% CI)P value
Gain in event-free survival — Invasive vs Conservative · at 5 years276 (151–400)P = 0.0001
Gain in event-free survival — Invasive vs Conservative · at 10 years337 (123–550)P = 0.0001

Primary endpoint by subgroups (major CV prognostic factors)

Results consistent across subgroups

Original publication

Long-Term Outcomes of Invasive vs Conservative Strategies for Older Patients With Non–ST-Segment Elevation Acute Coronary Syndromes. J Am Coll Cardiol. Published 21 November 2023. doi:10.1016/j.jacc.2023.09.809

Summarised from the published abstract; every number is checked against it

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