Invasive Management in Older Adults (≥80 Years) With Non-ST Elevation Myocardial Infarction

Boris Fishman, Amir Sharon, Edward Itelman, Avishai M. Tsur, Paul Fefer, Israel Moshe Barbash, Amit Segev, Shlomi Matetzky, Victor Guetta, Ehud Grossman, Elad Maor

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To evaluate the association of invasive management (coronary angiogram) with all-cause mortality among older adult (≥80 years of age) patients presenting with non–ST elevation myocardial infarction (NSTEMI) by frailty status. Patients and Methods: This study used a retrospective cohort of consecutive older adult patients who were hospitalized with NSTEMI as their primary clinical diagnosis between August 1, 2008, and December 31, 2019. Cox regression models were applied with stratification by frailty status (low, medium, and high). Extensive sensitivity analyses were conducted including propensity score matching and inverse probability treatment weighting models. Results: The study population included 2317 patients with median age of 86 years (IQR, 83-90 years) of whom 1243 (53.6%) were men. Patients who were managed invasively (n=581 [25%]) were less likely to be frail (7% vs 44%, P<.001). During the follow-up (median, 19 months, IQR, 4-41 months), 1599 (69%) patients died. In a multivariable Cox model, invasive approach was associated with adjusted hazard ratio (HR) of 0.61 (95% CI, 0.53 to 0.71) for the risk of death. The benefit of invasive approach was consistent among low, medium, and high frailty subgroups with adjusted HRs of 0.74 (95% CI, 0.58 to 0.93), 0.65 (95% CI, 0.50 to 0.85), and 0.52 (95% CI, 0.34 to 0.78), respectively (P for interaction = 0.48). Results were consistent with propensity score matching and inverse probability treatment weighting analyses (HR, 0.6; 95% CI, 0.50 to 0.71 and HR, 0.67; 95% CI, 0.55 to 0.82, respectively). Sensitivity analysis addressing potential immortal time bias and residual confounding yielded similar results. Conclusion: Invasive approach is associated with improved survival among older adults with NSTEMI irrespective of frailty status.

Original languageEnglish
Pages (from-to)1247-1256
Number of pages10
JournalMayo Clinic Proceedings
Volume97
Issue number7
DOIs
StatePublished - Jul 2022

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