The Impacts of In-Hospital Invasive Strategy on Long-Term Outcome in Elderly Patients with Non-ST-Elevation Myocardial Infarction.
BACKGROUND
The benefit of utilizing an invasive strategy in elderly Chinese patients with non-ST-elevation myocardial infarction (NSTEMI) remains unclear. The aim of this study was to determine whether in-hospital revascularization is associated with long-term prognosis in elderly Chinese patients with NSTEMI, as compared with younger patients.


METHODS
All patients were followed up for at least 3 years or until the occurrence of a major event. The primary endpoint was all-cause mortality, and the secondary endpoint was the combined occurrence of major adverse cardiovascular events (MACE), including death, nonfatal MI, and ischemic stroke.


RESULTS
A total of 343 consecutive NSTEMI patients (148 over the age of 75 years and 195 aged < 75 years) were enrolled. Coronary angiography was performed less frequently in elderly patients (66% vs. 76%; p = 0.027). Multiple logistic regression analysis confirmed the benefit of in-hospital revascularization in the elderly and younger patients, with a statistically significant reduction in the odds of all-cause death and MACE at 1 year and 3 years, respectively. In a multivariable Cox regression analysis, in-hospital revascularization was an independent predictor of future MACE not only in elderly patients [hazard ratio (HR), 0.61; 95% confidence interval (CI), 0.38-0.97] but also in younger patients as well (HR, 0.51; 95% CI, 0.31-0.84).


CONCLUSIONS
In Chinese patients with NSTEMI, in-hospital revascularization was associated with significant benefits at 1 year and 3 years in both younger and elderly groups. These results are consistent with the published literature and suggest that advanced age alone should not be regarded as a contraindication to invasive management following presentation with NSTEMI.


BACKGROUND
Elderly; Invasive strategy; Myocardial infarction.
Healthcare and Management Center, Taipei Veterans General Hospital; ; Institute of Clinical Medicine;
Shao-Sung
SS
Huang
Healthcare and Management Center, Taipei Veterans General Hospital; ; Institute of Clinical Medicine;
Hsin-Bnag
HB
Leu
Division of Cardiology, Department of Internal Medicine; ; Institute of Clinical Medicine;
Tse-Min
TM
Lu
Division of Cardiology, Department of Internal Medicine; ; Institute of Clinical Medicine;
Tao-Cheng
TC
Wu
Division of Cardiology, Department of Internal Medicine; ; Institute of Clinical Medicine;
Ying-Hwa
YH
Chen
Department of Medical Research and Education; ; Institute and Department of Pharmacology, National Yang-Ming University, Taipei, Taiwan.
Jaw-Wen
JW
Chen
Department of Medical Research and Education; ; Institute of Clinical Medicine;
Shing-Jong
SJ
Lin
Healthcare and Management Center, Taipei Veterans General Hospital;
Wan-Leong
WL
Chan