Medical management and watchful observation best for frail elders with Non-STEMI: JAMA
Spain: According to a recent original investigation published in JAMA Internal Medicine, considering non-ST-segment elevation acute myocardial infarction (NSTEMI) patients in frail older patients, a routine invasive strategy does not increase DAOH (days alive and out of hospital) during the first year.
More research needs to be done on comparing invasive and conservative strategies in frail, older patients with NSTEMI. There needs to be clarity regarding the role of a routine invasive approach in improving outcomes in older adults with frailty and NSTEMI.
Researchers from the University Clinic Hospital of València UniversityJAMA Hospital of Bellvitge researched the study mentioned above and interpreted the following points of conclusion:
They investigated the routine invasive vs conservative strategy in older adults with frailty and NSTEMI.
- A total of 167 participants were randomized and analyzed at 13 hospitals in Spain.
- The study had 79 men and 88 women with a mean age of 86 years.
- The study design included adults aged ≥ 70 y with NSTEMI and frailty defined by ≥ 4 points on the Clinical Frailty Scale.
- The mean Clinical Frailty Score was 5
- Eighty-four participants were randomized to a routine invasive strategy (coronary angiography and revascularization if deemed appropriate).
- Eighty-three participants were randomized to a conservative management strategy (medical treatment with coronary angiography only if recurrent ischemia).
- The study's primary outcome was the number of days alive and out of the hospital between discharge from index hospitalization to 1 year.
- The researchers reported no significant difference in DAOH between routine invasive and conservative management groups.
- DAOH were about one month greater for patients managed conservatively (312 days) vs patients managed invasively (284 days).
- There were no differences in all-cause mortality with a hazard ratio of 1.45
Due to the COVID-19 pandemic, the study was prematurely stopped (95% of the calculated sample size enrolled).
Concluding further, in frail older patients with NSTEMI, a routine invasive strategy did not increase the number of days alive out of hospital during the first year.
The study's results high point the required recommendations for the policy of watchful observation and careful evaluation for frail older patients with NSTEMI.
Further reading:
Sanchis J, Bueno H, Miñana G, et al. Effect of Routine Invasive vs Conservative Strategy in Older Adults With Frailty and Non–ST-Segment Elevation Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA Intern Med. Published online March 06, 2023.doi:10.1001/jamainternmed.2023.0047
