| Title: |
Invasive treatment strategy for older patients with myocardial infarction |
| Authors: |
Kunadian, V.; Mossop, H.; Shields, C.; Bardgett, M.; Watts, P.; Teare, M.D.; Pritchard, J.; Adams-Hall, J.; Runnett, C.; Ripley, D.P.; Carter, J.; Quigley, J.; Cooke, J.; Austin, D.; Murphy, J.; Kelly, D.; McGowan, J.; Veerasamy, M.; Felmeden, D.; Contractor, H.; Mutgi, S.; Irving, J.; Lindsay, S.; Galasko, G.; Lee, K.; Sultan, A.; Dastidar, A.G.; Hussain, S.; Haq, I.U.; de Belder, M.; Denvir, M.; Flather, M.; Storey, R.F.; Newby, D.E.; Pocock, S.J.; Fox, K.A.A. |
| Publisher Information: |
Massachusetts Medical Society |
| Publication Year: |
2024 |
| Collection: |
White Rose Research Online (Universities of Leeds, Sheffield & York) |
| Description: |
Background Whether a conservative strategy of medical therapy alone or a strategy of medical therapy plus invasive treatment is more beneficial in older adults with non–ST-segment elevation myocardial infarction (NSTEMI) remains unclear. Methods We conducted a prospective, multicenter, randomized trial involving patients 75 years of age or older with NSTEMI at 48 sites in the United Kingdom. The patients were assigned in a 1:1 ratio to a conservative strategy of the best available medical therapy or an invasive strategy of coronary angiography and revascularization plus the best available medical therapy. Patients who were frail or had a high burden of coexisting conditions were eligible. The primary outcome was a composite of death from cardiovascular causes (cardiovascular death) or nonfatal myocardial infarction assessed in a time-to-event analysis. Results A total of 1518 patients underwent randomization; 753 patients were assigned to the invasive-strategy group and 765 to the conservative-strategy group. The mean age of the patients was 82 years, 45% were women, and 32% were frail. A primary-outcome event occurred in 193 patients (25.6%) in the invasive-strategy group and 201 patients (26.3%) in the conservative-strategy group (hazard ratio, 0.94; 95% confidence interval [CI], 0.77 to 1.14; P=0.53) over a median follow-up of 4.1 years. Cardiovascular death occurred in 15.8% of the patients in the invasive-strategy group and 14.2% of the patients in the conservative-strategy group (hazard ratio, 1.11; 95% CI, 0.86 to 1.44). Nonfatal myocardial infarction occurred in 11.7% in the invasive-strategy group and 15.0% in the conservative-strategy group (hazard ratio, 0.75; 95% CI, 0.57 to 0.99). Procedural complications occurred in less than 1% of the patients. Conclusions In older adults with NSTEMI, an invasive strategy did not result in a significantly lower risk of cardiovascular death or nonfatal myocardial infarction (the composite primary outcome) than a conservative strategy over a median follow-up of 4.1 ... |
| Document Type: |
article in journal/newspaper |
| File Description: |
text |
| Language: |
English |
| ISSN: |
0028-4793 |
| Relation: |
https://eprints.whiterose.ac.uk/id/eprint/218576/3/Kunadian-2407791-Text.pdf; Kunadian, V. orcid.org/0000-0003-2975-6971 , Mossop, H., Shields, C. et al. (33 more authors) (2024) Invasive treatment strategy for older patients with myocardial infarction. New England Journal of Medicine, 391 (18). pp. 1673-1684. ISSN: 0028-4793 |
| Availability: |
https://eprints.whiterose.ac.uk/id/eprint/218576/ |
| Rights: |
cc_by_4 |
| Accession Number: |
edsbas.FACB1004 |
| Database: |
BASE |