title: Early invasive versus initial conservative treatment strategies in octogenarians with UA/NSTEMI.
abstract: BACKGROUND
  Previous studies have demonstrated improved outcomes with an early invasive strategy in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI). However, there are limited data for patients ≥80 years of age in these studies.
  
  
  METHODS
  We used the 2003-2010 Nationwide Inpatient Sample databases to identify all patients ≥80 years of age (octogenarians) with UA/NSTEMI. Multivariable logistic regression was used to compare in-hospital outcomes in octogenarians with UA/NSTEMI undergoing early invasive (coronary angiography within 48 hours of admission, with or without revascularization) versus initial conservative treatment.
  
  
  RESULTS
  Among 968,542 octogenarians with UA/NSTEMI, 806,902 (83.3%) were managed using an initial conservative approach and 161,640 (16.7%) using an early invasive strategy. Patients in the early invasive group were more likely to be younger, men, white, and had a higher prevalence of smoking, dyslipidemia, obesity, hypertension, known coronary artery disease, carotid artery disease, and peripheral vascular disease. In-hospital mortality was significantly lower in octogenarians in the early invasive group (adjusted odds ratio [OR] 0.76; 95% confidence interval [CI], 0.74-0.78). Early invasive strategy was associated with lower rates of acute ischemic stroke (adjusted OR 0.63; 95% CI, 0.60-0.66), intracranial hemorrhage (adjusted OR 0.60; 95% CI, 0.510.70), gastrointestinal bleeding (adjusted OR 0.63; 95% CI, 0.60-0.65), and shorter average length of stay (5.3 vs 5.8 days, P <.001), but higher cardiogenic shock (adjusted OR 2.14; 95% CI, 2.06-2.23) and total hospital cost (23,584 vs 13,278 USD).
  
  
  CONCLUSIONS
  Compared with an initial conservative approach, an early invasive strategy in octogenarians with UA/NSTEMI was associated with lower in-hospital mortality, acute ischemic stroke, intracranial hemorrhage, gastrointestinal bleeding, and shorter length of stay, but higher cardiogenic shock and total hospital cost.
authors.affiliation: Department of Medicine, New York Medical College, Valhalla, NY.
authors.forename: Dhaval
authors.initials: D
authors.lastname: Kolte
authors.forename: Sahil
authors.initials: S
authors.lastname: Khera
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Palaniswamy
authors.forename: Marjan
authors.initials: M
authors.lastname: Mujib
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.forename: Ali
authors.initials: A
authors.lastname: Ahmed
authors.forename: Diwakar
authors.initials: D
authors.lastname: Jain
authors.forename: William H
authors.initials: WH
authors.lastname: Frishman
authors.forename: Wilbert S
authors.initials: WS
authors.lastname: Aronow
mesh_terms: D000789:Angina, Unstable / Q000628:therapy*; D006328:Cardiac Catheterization; D017023:Coronary Angiography; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D009203:Myocardial Infarction / Q000628:therapy*; D016017:Odds Ratio; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
keywords: Early invasive strategy; Non-ST-elevation myocardial infarction; Octogenarians; Unstable angina