European Heart Journal Advance Access published online on November 2, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm464
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Effect of an invasive strategy on in-hospital outcome in elderly patients with non-ST-elevation myocardial infarction
Herzzentrum Ludwigshafen, Department of Cardiology, Medizinische Klinik B, Bremserstrasse 79,D-67063 Ludwigshafen, Germany
Received 7 March 2007; revised 30 August 2007; accepted 24 September 2007.
* Corresponding author. Tel: +49 621 503 4045; fax: +49 621 503 4002. E-mail address: uwe.zeymer{at}t-online.de
Aims: We sought to investigate the impact of an invasive treatment in elderly patients presenting with non-ST elevation myocardial infarction (NSTEMI) in clinical practice.
Methods and results: We analysed data of consecutive elderly patients (
75 years) with NSTEMI who were prospectively enrolled in the German Acute Coronary Syndromes registry between July 2000 and November 2002. Overall 1936 patients were divided into two groups: 1005 (51.9%) underwent coronary angiography and/or revascularization, 931 (48.1%) received conservative treatment. In the invasive group, percutaneous coronary intervention was performed in 37.5% within 48 h and in 17.6% after 48 h, whereas 9.8% underwent coronary artery bypass grafting within the hospital stay. In-hospital death (12.5 vs. 6.0%, P < 0.0001) and death/myocardial infarction (17.3 vs. 9.6%, P < 0.0001) occurred significantly less often in patients with invasive strategy. After adjustment of the confounding factors in the propensity score analysis the invasive strategy remained superior for mortality (OR 0.55, 95% CI 0.35–0.86) and death and non-fatal myocardial infarction (OR 0.51, 95% CI 0.35–0.75) and 1 year mortality (OR 0.56, 95% CI 0.38–0.81). Major bleeding complications tended to be more frequent in the invasive group (8.8 vs. 5.8%, P = 0.07).
Conclusion: In clinical practice, in elderly patients with NSTEMI, an invasive strategy is associated with an improved in-hospital and 1 year outcome but a trend towards more bleeding complications.
Key Words: Coronary angiography • Revascularization • Non ST-elevation myocardial infarction • Invasive strategy
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