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Observational Study
. 2019;144(3-4):79-89.
doi: 10.1159/000503442. Epub 2019 Nov 5.

Long-Term Survival after Invasive or Conservative Strategy in Elderly Patients with non-ST-Elevation Myocardial Infarction: A Prospective Cohort Study

Kristin Marie Kvakkestad  1   2   3 , Jon Michael Gran  4 , Jan Eritsland  5 , Charlotte Holst Hansen  5 , Eigil Fossum  5 , Geir Øystein Andersen  5 , Sigrun Halvorsen  5   6
Affiliations
Observational Study

Long-Term Survival after Invasive or Conservative Strategy in Elderly Patients with non-ST-Elevation Myocardial Infarction: A Prospective Cohort Study

Kristin Marie Kvakkestad et al. Cardiology. 2019.

Abstract

Background: The optimal management of elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) is still discussed. We aimed to study short- and long-term survival in NSTEMI patients ≥75 years managed with an invasive or a conservative strategy.

Methods: NSTEMI patients admitted to Oslo University Hospital Ulleval during 2005-2011 were included consecutively in a prospective registry. Vital status until December 31, 2013, was obtained from the Norwegian Cause of Death Registry. Patients ≥75 years were identified, and 30-day and 7-year survival were analyzed. Logistic- and Cox regression was used to estimate OR and hazard ratio (HR) for death in the invasive versus conservative group, adjusting for registered confounders.

Results: There were 2,064 NSTEMI patients ≥75 years (48.2% women); 1,200 (58.1%) were treated with an invasive strategy, and were younger, more likely to be male and previously revascularized compared to 864 (41.9%) patients treated conservatively (p < 0.0001 for all). Survival at 30-day was 94.9% in the invasive and 76.6% in the conservative group. For 30-day survivors, 7-year survival was 47.4% (95% CI 42.9-51.8) and 11.6% (95% CI 8.3-15.6), respectively. After multivariate adjustment, an invasive strategy was associated with lower long-term risk (adjusted HR [aHR] 0.49 [95% CI 0.41-0.59]). Actual revascularization was associated with lower risk of long-term mortality compared to angiography only (aHRPCI 0.73 [95% CI 0.59-0.90], aHRCABG 0.43 [95% CI 0.28-0.65]).

Conclusion: In this real-life cohort of NSTEMI patients ≥75 years, 30-day survival was 95%, and 7-year survival was 47% with an invasive strategy. Revascularized patients had a superior long-term prognosis. With a conservative strategy, short- and long-term survival was lower, probably due to selection bias and unmeasured confounding.

Keywords: Elderly; Invasive strategy; Long-term survival; Non-ST-segment elevation myocardial infarction.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Flow chart. * During index hospitalization. AMI, acute myocardial infarction; NSTEMI, non-ST-elevation myocardial infarction; STEMI, ST-elevation myocardial infarction.
Fig. 2
Fig. 2
30-day survival. Patients aged ≥75 years with NSTEMI. Kaplan-Meier survival plot.
Fig. 3
Fig. 3
Long-term survival. NSTEMI patients ≥75 years alive at day 30 (Landmark analysis). Kaplan-Meier survival plot. Median follow-up 1,155 days (25–75th percentile: 634–1,687).
Fig. 4
Fig. 4
Actual revascularization. NSTEMI patients ≥75 years managed with angiography only (a), angiography + PCI (b) or angiography + CABG (c). a 30-Day survival. Kaplan-Meier survival plot. b Long-term survival after 30 days. Kaplan-Meier survival plot. PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; revasc, revascularization.
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References

    1. Lagerqvist B, Husted S, Kontny F, Ståhle E, Swahn E, Wallentin L, Fast Revascularisation during InStability in Coronary artery disease (FRISC-II) Investigators 5-year outcomes in the FRISC-II randomised trial of an invasive versus a non-invasive strategy in non-ST-elevation acute coronary syndrome: a follow-up study. Lancet. 2006 Sep;368((9540)):998–1004. - PubMed
    1. Fox KA, Clayton TC, Damman P, Pocock SJ, de Winter RJ, Tijssen JG, et al. FIR Collaboration Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data. J Am Coll Cardiol. 2010 Jun;55((22)):2435–45. - PubMed
    1. Damman P, Clayton T, Wallentin L, Lagerqvist B, Fox KA, Hirsch A, et al. Effects of age on long-term outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes: a collaborative analysis of individual data from the FRISC II - ICTUS - RITA-3 (FIR) trials. Heart. 2012 Feb;98((3)):207–13. - PubMed
    1. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, Andreotti F, et al. ESC Scientific Document Group 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC) Eur Heart J. 2016 Jan;37((3)):267–315. - PubMed
    1. Amsterdam EA, Wenger NK, Brindis RG, Casey DE, Jr, Ganiats TG, Holmes DR, Jr, et al. ACC/AHA Task Force Members. Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014 Dec;130((25)):2354–94. - PubMed

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