NYMC Faculty Publications
Early Invasive Versus Initial Conservative Treatment Strategies in Octogenarians With UA/NSTEMI
Author Type(s)
Faculty
DOI
10.1016/j.amjmed.2013.07.024
Journal Title
The American Journal of Medicine
First Page
1076
Last Page
1083
Document Type
Article
Publication Date
12-1-2013
Abstract
BACKGROUND: Previous studies have demonstrated improved outcomes with an early invasive strategy in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI). However, there are limited data for patients ≥80 years of age in these studies.
METHODS: We used the 2003-2010 Nationwide Inpatient Sample databases to identify all patients ≥80 years of age (octogenarians) with UA/NSTEMI. Multivariable logistic regression was used to compare in-hospital outcomes in octogenarians with UA/NSTEMI undergoing early invasive (coronary angiography within 48 hours of admission, with or without revascularization) versus initial conservative treatment.
RESULTS: Among 968,542 octogenarians with UA/NSTEMI, 806,902 (83.3%) were managed using an initial conservative approach and 161,640 (16.7%) using an early invasive strategy. Patients in the early invasive group were more likely to be younger, men, white, and had a higher prevalence of smoking, dyslipidemia, obesity, hypertension, known coronary artery disease, carotid artery disease, and peripheral vascular disease. In-hospital mortality was significantly lower in octogenarians in the early invasive group (adjusted odds ratio [OR] 0.76; 95% confidence interval [CI], 0.74-0.78). Early invasive strategy was associated with lower rates of acute ischemic stroke (adjusted OR 0.63; 95% CI, 0.60-0.66), intracranial hemorrhage (adjusted OR 0.60; 95% CI, 0.510.70), gastrointestinal bleeding (adjusted OR 0.63; 95% CI, 0.60-0.65), and shorter average length of stay (5.3 vs 5.8 days, P
CONCLUSION: Compared with an initial conservative approach, an early invasive strategy in octogenarians with UA/NSTEMI was associated with lower in-hospital mortality, acute ischemic stroke, intracranial hemorrhage, gastrointestinal bleeding, and shorter length of stay, but higher cardiogenic shock and total hospital cost.
Recommended Citation
Kolte, D., Khera, S., Palaniswamy, C., Mujib, M., Fonarow, G., Ahmed, A., Jain, D., Frishman, W., & Aronow, W. S. (2013). Early Invasive Versus Initial Conservative Treatment Strategies in Octogenarians With UA/NSTEMI. The American Journal of Medicine, 126 (12), 1076-1083. https://doi.org/10.1016/j.amjmed.2013.07.024
