Rubino Francesca, Pompei Graziella, Mills Gregory B, Kotanidis Christos P, Laudani Claudio, Bendz Bjørn, Berg Erlend S, Hildick-Smith David, Hirlekar Geir, Morici Nuccia, Myat Aung, Tegn Nicolai, Sanchis Forés Juan, Savonitto Stefano, De Servi Stefano, Kunadian Vijay
Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK.
Department of Cardiology, HartCentrum, Ziekenhuis aan de Stroom (ZAS) Middelheim, Lindendreef 1, 2020 Antwerp, Belgium.
Eur Heart J Open. 2024 Oct 26;4(6):oeae093. doi: 10.1093/ehjopen/oeae093. eCollection 2024 Nov.
Women and older patients are underrepresented in randomized controlled trials (RCTs) investigating treatment strategies following acute coronary syndrome. This study aims to evaluate the benefit of invasive vs. conservative strategy of older women with non-ST-elevation acute coronary syndrome (NSTEACS).
This analysis from an individual patient data meta-analysis included six RCTs comparing an invasive management with a conservative management in older NSTEACS patients. The primary endpoint was the composite of all-cause mortality or myocardial infarction (MI). Secondary endpoints included all-cause mortality, cardiovascular death, MI, urgent revascularization, and stroke. Follow-up time was censored at 1 year. In total, 717 women [median age 84.0 (interquartile range 81.0-87.0) years] were included. The primary endpoint occurred in 21.0% in the invasive strategy vs. 27.8% in the conservative strategy [hazard ratio (HR) 0.77, 95% confidence interval (CI) 0.52-1.13, = 0.160 using random effect] at 1-year follow-up. The invasive management was associated with reduced risk of MI (HR 0.49, 95% CI 0.32-0.73, < 0.001) and urgent revascularization (HR 0.44, 95% CI 0.20-0.98, = 0.045). No significant differences were identified in the risk of all-cause mortality, cardiovascular death, and stroke. Among males, there was no significant association between the treatment strategy and primary or secondary endpoints.
An invasive strategy compared with a conservative strategy did not reduce the composite outcome of all-cause mortality or MI in older NSTEACS women at 1-year follow-up. An invasive strategy reduced the individual risk of MI and urgent revascularization. Our results support the beneficial role of the invasive strategy in older NSTEACS women.
This meta-analysis is registered with PROSPERO (CRD42023379819).
在调查急性冠状动脉综合征后治疗策略的随机对照试验（RCT）中，女性和老年患者的代表性不足。本研究旨在评估非ST段抬高型急性冠状动脉综合征（NSTEACS）老年女性采用侵入性策略与保守策略的获益情况。
这项基于个体患者数据的荟萃分析纳入了6项RCT，比较了老年NSTEACS患者的侵入性管理与保守管理。主要终点是全因死亡率或心肌梗死（MI）的复合终点。次要终点包括全因死亡率、心血管死亡、MI、紧急血运重建和中风。随访时间以1年为截尾。总共纳入了717名女性[中位年龄84.0（四分位间距81.0 - 87.0）岁]。在1年随访时，侵入性策略组主要终点的发生率为21.0%，保守策略组为27.8%[风险比（HR）0.77，95%置信区间（CI）0.52 - 1.13，采用随机效应时P = 0.160]。侵入性管理与MI风险降低（HR 0.49，95% CI 0.32 - 0.73，P < 0.001）和紧急血运重建风险降低（HR 0.44，95% CI 0.20 - 0.98，P = 0.045）相关。在全因死亡率、心血管死亡和中风风险方面未发现显著差异。在男性中，治疗策略与主要或次要终点之间无显著关联。
在1年随访中，与保守策略相比，侵入性策略并未降低老年NSTEACS女性全因死亡率或MI的复合结局。侵入性策略降低了MI和紧急血运重建的个体风险。我们的结果支持侵入性策略在老年NSTEACS女性中的有益作用。
本荟萃分析已在PROSPERO（CRD42023379819）注册。
