The effect of invasive management in elderly patients after a heart attack

This article investigated the safety and effectiveness of invasive treatment in the management of patients that had an ST-elevation myocardial infarction (STEMI; heart attack). The authors concluded that invasive treatment caused lower adverse events in older high-risk patients. 

Multimorbidity (MM) is the presence of two or more chronic conditions or diseases in a patient. The current strategy for treating elderly patients with MM and a STEMI is a non-invasive technique. 

An alternative treatment method is using an invasive technique. This treatment uses primary percutaneous coronary interventions (PCI; uses a thin flexible tube inserted through a thigh artery to place a stent to open up blood vessels in the heart that have been narrowed by plaque build-up). 

However, the effect on overall effectiveness and safety of an invasive technique in elderly patients with MM are still under investigation.

This study involved 1659 patients who were 70 years or older. All patients had a STEMI and MM. The patients were split into two groups. Group 1 had received invasive therapy (1089). Group 2 had non-invasive therapy (570). They were followed up at 1 year. Cardiovascular events (CVe) such as another heart attack, stroke or death were measured. 

The in-hospital death risk was 26% higher in the non-invasive group compared to the invasive group. After 1 year follow-up, readmission for a CVe occurred in 31% of group 1 and 55% of group 2. Group 1 was 33% less likely to have a CVe than group 2. Death at one year was 18% in group 1 and 45% in group 2. Group 1 was 49% less likely to die at one year compared to group 2.  

The authors concluded that invasive treatment caused lower a lower risk of CVe in older high-risk patients with STEMI compared to a non-invasive treatment. 

The patients in this study were not randomized. The choice of the group was selected based on doctor and patients' choice. This might have influenced the results.