Managing non-ST elevation myocardial infarction in the elderly – is an invasive or non-invasive approach more suitable?

This study investigated the management of non-ST elevation myocardial infarction (NSTEMI) in elderly patients.

They found that invasive management had better survival rates for these patients. 

Coronary artery disease (CAD) is caused by reduced blood flow to the heart. This can be caused by blockages. CAD can lead to a heart attack. Myocardial infarction (MI) is the medical term for a heart attack. An electrocardiogram (ECG) is used to detect an MI. One type of MI is called non-ST elevation MI (NSTEMI). NSTEMI can be managed using invasive or non-invasive strategies. Invasive management involves surgical procedures. The aim of this is to remove any clots in the arteries. 

Non-invasive management is another option. This can involve medications to reduce the risk of another MI. This can be achieved by lowering blood pressure or taking blood-thinning medication. Studies have compared invasive and non-invasive in patients with NSTEMI. However, these studies did not include patients over the age of 80. It is unclear if invasive or non-invasive management is more effective in elderly patients with NSTEMI. 

This study included 1500 patients with NSTEMI. All were aged 80 or older. Patients underwent either invasive treatment (44%) or non-invasive treatment (56%) at their doctor’s discretion. The authors compared outcomes such as mortality rate or hospitalization rate. The average follow-up period was 3 years.

The 5-year mortality rate was 36% in the invasive groups and 55% in the non-invasive group. Invasive management was associated with a 32% lower mortality risk compared to a non-invasive management. Invasive management was also associated with 33% lower risk for hospital addmission for heart failure. 

The authors concluded that invasive management was associated with better outcomes in elderly patients with NSTEMI. 

This was an observational study. There could be other factors affecting the results. Quality of life was not measured. This could have an important impact on the use of invasive management in the elderly. 

If you have any concerns regarding CAD management please consult with your doctor.