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REVIEW ARTICLE
Year : 2019  |  Volume : 3  |  Issue : 4  |  Page : 111-118

The risks and the benefits of early invasive strategy compared to conservative strategy in elderly patients with non-ST-elevated myocardial infarction or unstable angina: a systematic review and meta-analysis


Department of Biomedical Sciences, Meena Research Group, School of Clinical and Applied Sciences, Leeds Beckett University, Leeds, England, UK, England

Correspondence Address:
Dr. Osama A Tashani
School of Clinical and Applied Sciences, Leeds Beckett University, Leeds
England
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/LJMS.LJMS_55_19

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Background and Aim: Compared with their younger counterparts, the elderly with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTMI) has been proven to have worse outcomes. People with UA/NSTEMI are managed with a combination of medical therapy, invasive angiography, and revascularization. A systematic review and meta-analysis was conducted to compare the effects and the benefits associated with the routine invasive approach versus a conservative or “selective invasive” approach for the management of UA/NSTEMI in the elderly. Methods: Data from randomized controlled trials (RCTs) were identified through search strategy filters. Five search engines and databases were searched systematically, namely PubMed, CINAHL, ScienceDirect, Web of Science, and Cochrane Library. The primary outcome of the analysis was the composite of all-cause death and myocardial infarction (MI). Results: Four RCTs with total of 3016 patients were eligible. We calculated the log risk ratio with 95% confidence intervals (CIs) for the primary endpoints of all-cause death and MI. The study analysis did not show appreciable risk reductions in all-cause mortality (log risk ratio: 0.142 and 95% CI = 0.363–0.78, 4 studies, 3016 participants, and low-quality evidence). However, it shows that there was a significant risk reduction in the incidence of MI (log risk ratio 0.519, 95% CI = 0.707–0.331, 4 studies, 3016 participants, and low quality of evidence). Conclusion: A routine invasive approach in the elderly with UA/NSTMI was not associated with any significance in terms of mortality compared with conservative approach. However, research suggests that the invasive strategy may have particular benefit in the elderly who are at high risk for recurrent events and that patients at low risk for a recurrent event may even suffer harm from such strategy approach.


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