title: Early invasive versus selectively invasive strategy in patients with non-ST-segment elevation acute coronary syndrome: impact of age.
abstract: BACKGROUND
  It is unclear whether the benefits of an early invasive strategy (EIS) in patients with non-ST-segment elevation acute coronary syndromes (NSTEACS) equally apply to younger and older individuals. Elderly patients are generally less likely to undergo EIS when compared with younger patients.
  
  
  OBJECTIVE
  We conducted a meta-analysis to compare the benefit of an EIS versus a selectively invasive strategy (SIS) in patients with NSTEACS. We tested the hypothesis that the magnitude of benefit of an EIS over a SIS mainly applies to older individuals.
  
  
  METHODS
  We extracted data from randomized controlled trials (RCTs) identified through search methodology filters. The primary outcome of the analysis was the composite of all-cause death and myocardial infarction (MI). Secondary outcomes were death and MI taken alone and re-hospitalization.
  
  
  RESULTS
  Nine trials (n = 9,400 patients) were eligible. The incidence of the composite end-point of MI and all-cause death was 16.0% with the EIS and 18.3% with the SIS (OR: 0.85, 95% CI: 0.76-0.95). The incidence of MI was 8.4% with the EIS and 10.9% with the SIS (OR: 0.75, 95% CI: 0.66-0.87). Similar results were obtained for rehospitalization (OR: 0.71, 95% CI: 0.55-0.90). The incidence of all-cause death did not differ between the two groups. The EIS reduced the composite end-point and re-hospitalization to a greater extent in elderly than in younger patients (P for interaction = 0.044 and <0.0001, respectively). These findings were confirmed in meta-regression analyses.
  
  
  CONCLUSIONS
  In patients with NSTEACS, a routine EIS reduces the risk of rehospitalization and the composite end point of recurrent MI and death to a greater extent in elderly than in younger individuals.
authors.affiliation: Division of Cardiology and Cardiovascular Pathophysiology, Teaching Hospital "S.M. della Misericordia,", Perugia, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Angeli
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
authors.forename: Nuccia
authors.initials: N
authors.lastname: Morici
authors.forename: Stefano
authors.initials: S
authors.lastname: De Servi
authors.forename: Claudio
authors.initials: C
authors.lastname: Cavallini
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000367:Age Factors; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: acute coronary syndrome; early invasive strategy; meta-analysis; percutaneous coronary intervention; prognosis