SAN DIEGO — An early invasive strategy yielded better outcomes than a conservative strategy for patients aged at least 80 years with non-STEMI or unstable angina, according to the results of the After Eighty study presented at the American College of Cardiology Scientific Sessions.
Patients aged at least 80 years are underrepresented in clinical trials, and there is little consensus on whether they should be managed with an invasive or conservative strategy when they present with non-STEMI or unstable angina, Nicolai K. Tegn, MD, said at a press conference.
Nicolai K. Tegn
Tegn, a cardiologist at Rikshospitalet Oslo University Hospital, Norway, and colleagues randomly assigned 457 patients aged at least 80 years with non-STEMI or unstable angina to one of two groups. Both received optimal medical treatment. One group also was transported to a PCI center the day after randomization for an evaluation in the cath lab with subsequent PCI or CABG if necessary.
The primary endpoint was a composite of MI, urgent revascularization, stroke and death during a median follow-up of 1.51 years.
Compared with the conservative group, the invasive group was significantly less likely to experience the primary endpoint (41% vs. 61%; rate ratio = 0.48; 95% CI, 0.37-0.63), the researchers found.
Tegn said the results were driven by differences in the rates of MI (17% vs. 30%; rate ratio = 0.5; 95% CI, 0.33-0.75) and urgent revascularization (2% vs. 11%; rate ratio = 0.19; 95% CI, 0.05-0.52).
The invasive group also had a lower rate of death or MI (35% vs. 48%; rate ratio = 0.54; 95% CI, 0.4-0.73), he said.
There were no differences between the groups in the incidence of bleeding complications, Tegn said, noting that four patients in each group experienced major bleeds.
“Our study demonstrated that an invasive strategy is superior to a conservative strategy in patients over 80 years with non-STEMI or unstable angina,” Tegn said. – by Erik Swain
Tegn NK, et al. Late-Breaking Clinical Trials V: TCT@ACC-i2. Presented at: American College of Cardiology Scientific Sessions; March 14-16, 2015; San Diego.
Disclosure: The study was funded by the Norwegian Health Association. Tegn reports no relevant financial disclosures.