Abstract

Research Article

Conservative treatment versus invasive approach in elderly patients with myocardial infarction without ST-segment elevation

Alexandra Cozma*, Adriana Ardelean, Katalin Babes and Mircea Ioachim Popescu

Published: 30 April, 2020 | Volume 5 - Issue 1 | Pages: 101-104

Myocardial infarction without ST segment elevation is one of the most common causes of hospitalization of the elderly patient [1]. Coronarography followed by revascularization, is performed in the vast majority of cases of myocardial infarction without ST segment elevation, in the regions with a well-developed health system. The decision to perform the procedure, the type of approach (early/late) and the selection of the type of myocardial revascularization depend on numerous factors such as: associated comorbidities, clinical presentation, the risk group in which the patient is framed, fragility, cognitive status, life expectancy etc. [2,3]. Older patients often present with various comorbidities, having a higher risk of complications and an unfavorable evolution. Thus, it was observed that invasively treatment is less commonly used in elderly patients with comorbidities, even if, the current guideline recommends that the invasive strategy should be considered in all patients with NSTEMI, regardless of age. At the same time, this subgroup of patients is not so well represented in the studies performed so far, the type of treatment chosen, being most often at the discretion of the attending physician [1,2].

Objective The present study aims to analyze the evolution of a subgroup of patients ≥ 70 years of age, with different comorbidities, with the diagnosis of myocardial infarction without ST segment elevation, according to the type of treatment applied: conservative versus invasive strategy (diagnostic coronarography ± revascularization, if appropriate).

Read Full Article HTML DOI: 10.29328/journal.jccm.1001094 Cite this Article Read Full Article PDF

Keywords:

Elderly; Non ST myocardial infarction; Treatment; Comorbidities; Mortality

References

  1. Tegn N, Abdelnoor M, Aaberge L, Endresen K, Smith P, et al. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. Lancet. 2016; 387: 1057-1065. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26794722
  2. Roffi M, Patrono C, Collet JP, Mueller C, Valgimigli M, et al. 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; 37: 267–315. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26320110
  3. Sanchis J, Ariza-Solé A, Abu-Assi E, Alegre O, Alfonso F, et al. Invasive Versus Conservative Strategy in Frail Patients With NSTEMI: The MOSCA-FRAIL Clinical Trial Study Design”, Revista Espanola de Cardiologia. 2019; 72: 154-159. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29525724
  4. Stefano S, Nuccia M, Stefano DS, Treatment of Acute Coronary Syndromes in the Elderly and in Patients With Comorbidities. Revista Espanola de Cardiologia. 2014; 67: 564-573.
  5. Negers A, Boddaert J, Mora L, Golmard JL, Moïsi L, et.al. Determinants of invasive strategy in elderly patients with non-ST elevation myocardial infarction”,Journal of Geriatric Cardiology. 2017; 14: 465–472. PubMed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545189/
  6. Savonitto S, Cavallini C, Petronio AS, Murena E, Antonicelli R, et al. Early Aggressive Versus Initially Conservative Treatment in Elderly Patients With Non–ST-Segment Elevation Acute Coronary Syndrome: A Randomized Controlled Trial. JACC: Cardiovascular Interventions. 2012; 5: 906-916, PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22995877
  7. Cheng-Chun Wei, Shih-Huang Lee, Predictors of Mortality in Elderly Patients with Non-ST Elevation Acute Coronary Syndrome - Data from Taiwan Acute Coronary Syndrome Full Spectrum Registry”. Acta Cardiologica Sinica. 2017; 33: 377-383. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29033508

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More