Routine Invasive vs Conservative Management of NSTEMI in Elderly Patients: Updated Meta-Analysis of Randomized Trials
Authors' conclusion
In elderly patients with NSTEMI, routine invasive strategy does not improve primary outcomes of all-cause mortality or cardiac-related death but may reduce recurrent myocardial infarction and the need for urgent revascularization.
Study context
- Population
- Patients aged ≥70 years with NSTEMI
- Participants
- 3,275 patients8 RCTs
- Comparison
- Routine invasive strategy vs conservative management
- Outcome
- All-cause mortality and cardiac-related death
Methodological detailsinverse-variance weighting, frequentist
- Inverse-variance weighting
- Frequentist
Pooled result
As reported in the abstract
Invasive vs ConservativeOdds ratio (95% CI)P value
All-cause mortality; I2: 0%
1.07(0.90–1.26)
P = 0.44Cardiac-related death; I2: 0%
1.05(0.86–1.29)
P = 0.64Further pooled results
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Myocardial reinfarctionI2: 34% | 0.71 (0.58–0.86) | P = 0.0005 | |
| Urgent revascularizationI2: 0% | 0.31 (0.23–0.42) | P < 0.00001 | |
| 0.20.5125Odds ratio (log scale) |
Safety
| Outcome | OR (95% CI) | P value | |
|---|---|---|---|
| Cerebrovascular accidentI2: 0% | 1.13 (0.82–1.55) | P = 0.45 | |
| 0.512Odds ratio (log scale) |
Original publication
Routine Invasive vs Conservative Management of NSTEMI in Elderly Patients: Updated Meta-Analysis of Randomized Trials. JACC Adv. Published 29 October 2025. doi:10.
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