{"id":"8a492e033cbe","type":"article","url":"https://hartvaat.nl/2024/06/14/invasief-versus-conservatief-bij-ouderen-met-nste-acs-ipd-meta-analyse/","title":"Invasief versus conservatief bij ouderen met NSTE-ACS: IPD meta-analyse","title_en":"Invasive vs. conservative management of older patients with non-ST-elevation acute coronary syndrome: individual patient data meta-analysis.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["hartkatheterisatie"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehae151","source_url":"https://doi.org/10.1093/eurheartj/ehae151","authors":["Christos P Kotanidis","Gregory B Mills","Bjørn Bendz","Erlend S Berg","David Hildick-Smith","Geir Hirlekar","Dejan Milasinovic","Nuccia Morici","Aung Myat","Nicolai Tegn","Juan Sanchis","Stefano Savonitto","Stefano De Servi","Keith A A Fox","Stuart Pocock","Vijay Kunadian"],"significance":8,"published":"2024-06-14","source_date":"2024-06-14","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/peripartum-cardiomyopathie/","https://hartvaat.nl/kennis/kleplijden/aortastenose/"],"congress":"","summary_en":"This individual patient data meta-analysis confirmed that early invasive management reduces MI and repeat revascularization in older patients with NSTE-ACS compared with conservative management. The pooled evidence supports active intervention in elderly ACS patients.","created":"2026-07-03T10:30:59Z","updated":"2026-07-03T13:30:02Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"IPD meta-analyse vergeleek invasieve met conservatieve behandeling bij ouderen met NSTE-ACS. Een vroege invasieve strategie verminderde MI en herhaalde revascularisatie ook bij ouderen, zonder toename van ernstige bloedingen.","abstract_original":"BACKGROUND AND AIMS: Older patients with non-ST-elevation acute coronary syndrome (NSTEACS) are less likely to receive guideline-recommended care including coronary angiography and revascularization. Evidence-based recommendations regarding interventional management strategies in this patient cohort are scarce. This meta-analysis aimed to assess the impact of routine invasive vs. conservative management of NSTEACS by using individual patient data (IPD) from all available randomized controlled trials (RCTs) including older patients. METHODS: MEDLINE, Web of Science and Scopus were searched between 1 January 2010 and 11 September 2023. RCTs investigating routine invasive and conservative strategies in persons >70 years old with NSTEACS were included. Observational studies or trials involving populations outside the target range were excluded. The primary endpoint was a composite of all-cause mortality and myocardial infarction (MI) at 1 year. One-stage IPD meta-analyses were adopted by use of random-effects and fixed-effect Cox models. This meta-analysis is registered with PROSPERO (CRD42023379819). RESULTS: Six eligible studies were identified including 1479 participants. The primary endpoint occurred in 181 of 736 (24.5%) participants in the invasive management group compared with 215 of 743 (28.9%) participants in the conservative management group with a hazard ratio (HR) from random-effects model of 0.87 (95% CI 0.63-1.22; P = .43). The hazard for MI at 1 year was significantly lower in the invasive group compared with the conservative group (HR from random-effects model 0.62, 95% CI 0.44-0.87; P = .006). Similar results were seen for urgent revascularization (HR from random-effects model 0.41, 95% CI 0.18-0.95; P = .037). There was no significant difference in mortality. CONCLUSIONS: No evidence was found that routine invasive treatment for NSTEACS in older patients reduces the risk of a composite of all-cause mortality and MI within 1 year compared with conservative management. However, there is convincing evidence that invasive treatment significantly lowers the risk of repeat MI or urgent revascularisation. Further evidence is needed from ongoing larger clinical trials."}