title: Outcomes of early invasive treatment strategy in elderly patients with non-ST elevation acute coronary syndromes.
abstract: BACKGROUND
  As benefits of revascularization in non-ST elevation acute coronary syndromes (NSTEACSs) in the elderly are still unproven, we sought to assess the association between invasive or conservative management of NSTEACS and short-, mid- and long-term mortality or composite outcome of all-cause mortality and myocardial infarction in a cohort of consecutive elderly patients.
  
  
  RESULTS
  Consecutive NSTEACS patients older than 75 years discharged between 2006 and 2010 from a single intensive cardiac care unit, and managed with invasive or conservative strategy according to available guidelines were retrospectively surveyed. By multivariate regression and sensitivity analysis, crude and adjusted mortality and composite outcome were estimated at prespecified time points of short-term (in-hospital or 30 days mortality), mid-term (T1: 31 days to 6 months), and long-term (T2: 31 days to 12 months). A total of 453 patients (median age 80 years, 47% men) were evaluated; 301 (66.5%) underwent invasive treatment. Invasive was associated with significantly lower risk of short- [odds ratio (OR) 0.28, 95% confidence interval (CI) 0.12-0.67, P = 0.004], mid- (OR 0.33, 95% CI 0.16-0.67, P = 0.003) and long-term mortality (OR 0.34, 95% CI 0.20-0.58, P < .0001). Invasive strategy was also associated with nonsignificant lower short- (OR 0.55, 95% CI 0.28-1.07, P = 0.077), and highly significant lower mid- (OR 0.52, 95% CI 0.34-0.81, P = 0.003) and long-term adjusted cumulative composite outcome rate (OR 0.68, 95% CI 0.46-0.98, P = 0.004).
  
  
  CONCLUSIONS
  In NSTEACS elderly patients, invasive strategy is independently associated with lower short-, mid- and long-term mortality and composite outcome.
authors: aDivision of Cardiology, Department of Clinical and Molecular Medicine, Sapienza University of Rome, Ospedale Sant'AndreabDepartment of Epidemiology, Lazio Regional Health Service, RomecIRCCS Neuromed, Pozzilli (IS), Italy.
authors: Elena
authors: E
authors: Conti
authors: Maria B
authors: MB
authors: Musumeci
authors: Jasmine P
authors: JP
authors: Desideri
authors: Martina
authors: M
authors: Ventura
authors: Danilo
authors: D
authors: Fusco
authors: Luigi
authors: L
authors: Zezza
authors: Marco
authors: M
authors: De Giusti
authors: Andrea
authors: A
authors: Berni
authors: Pietro
authors: P
authors: Francia
authors: Massimo
authors: M
authors: Volpe
authors: Camillo
authors: C
authors: Autore
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome