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Invasive Treatment Tied to Better Outcomes in Elderly With NSTEMI

Mortality, incidence of hospital admission for heart failure lower in ≥80s with invasive management

THURSDAY, Sept. 3, 2020 (HealthDay News) — Invasive management is beneficial for patients with non-ST elevation myocardial infarction (NSTEMI) aged 80 years or older, according to a study published online Aug. 27 in The Lancet.

Amit Kaura, M.B.Ch.B., from Imperial College London, and colleagues estimated the effectiveness of invasive versus noninvasive management within three days of peak troponin concentration on survival for patients aged 80 years and older with NSTEMI. Data were obtained for 1,976 patients with NSTEMI from five collaborating hospitals in the United Kingdom; 101 died within three days of their peak troponin concentration and 375 were excluded with extreme propensity scores, leaving 1,500 patients in the analysis.

The researchers found that 56 percent of the patients received noninvasive management. Overall, 41 percent of patients died during a median follow-up of 3.0 years. The adjusted cumulative five-year mortality was 36 and 55 percent in the invasive management and noninvasive management groups, respectively (adjusted hazard ratio, 0.68). A lower incidence of hospital admission for heart failure was seen in association with invasive management compared with noninvasive management (adjusted rate ratio, 0.67).

“The gold standard is to base treatment decisions on evidence from randomized [controlled] trials, but that doesn’t yet exist for this group of patients,” Kaura said in a statement. “In the interim, we’ve done the next best thing, by looking at retrospective data gathered from these five large hospitals and using it like a clinical trial. The results are clear: Clinicians should positively consider invasive management for any patients over 80 diagnosed with an NSTEMI.”

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