Routine Invasive Versus Selective Invasive Strategy in Elderly Patients Older Than 75 Years With Non-ST-Segment Elevation Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Mayo Clin Proc. 2018 Apr;93(4):436-444. doi: 10.1016/j.mayocp.2017.11.022. Epub 2018 Feb 10.


Objective: To evaluate outcomes of routine invasive strategy (RIS) compared with selective invasive strategy (SIS) in elderly patients older than 75 years with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).

Methods: We systematically searched databases for randomized controlled trials (RCTs) between January 1, 1990, and October 1, 2016, comparing RIS with SIS for elderly patients (age>75 years) with NSTE-ACS. Random effects meta-analysis was conducted to estimate odds ratio (OR) with 95% CIs for composite of death or myocardial infarction (MI), and individual end points of all-cause death, cardiovascular (CV) death, MI, revascularization, and major bleeding.

Results: A total of 6 RCTs with 1887 patients were included in the final analysis. Compared with an SIS, RIS was associated with significantly decreased risk of the composite end point of death or MI (OR, 0.65; 95% CI, 0.51-0.83). Similarly, RIS led to a significant reduction in the risk of MI (OR, 0.51; 95% CI, 0.40-0.66) and need for revascularization (OR, 0.31; 95% CI, 0.11-0.91) compared with SIS. There were no significant differences between RIS and SIS in terms of all-cause death (OR, 0.85; 95% CI, 0.63-1.20), CV death (OR, 0.84; 95% CI, 0.61-1.15), and major bleeding (OR, 1.96; 95% CI, 0.97-3.97).

Conclusion: In elderly patients older than 75 years with NSTE-ACS, RIS is superior to SIS for the composite end point (death or MI), primarily driven by reduced risk of MI.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Acute Coronary Syndrome / complications
  • Acute Coronary Syndrome / mortality*
  • Acute Coronary Syndrome / therapy*
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Conservative Treatment / methods
  • Conservative Treatment / statistics & numerical data*
  • Coronary Angiography / statistics & numerical data*
  • Female
  • Humans
  • Male
  • Myocardial Infarction / mortality
  • Myocardial Infarction / prevention & control*
  • Myocardial Infarction / therapy
  • Myocardial Revascularization
  • Randomized Controlled Trials as Topic
  • Risk Factors