Invasive versus conservative medical management in NSTEMI patients aged ≥75 years: A retrospective cohort study

4923
HC Tang1, V Sharma1,2,3, Y Purmah1
1 Midland Metropolitan University Hospital, 2 University of Birmingham, 3 Aston University
Scientific Research
SP - Cardio (Cardiovascular)
Cardiovascular
View DOI

Abstract

Introduction

Invasive and conservative medical management strategies are widely used in the treatment of Non-ST-segment Elevation Myocardial Infarction (NSTEMI). Multiple studies have demonstrated no significant long term survival benefit of invasive management in patients aged ≥75 years old presenting with NSTEMI compared to conservative management. Therefore, the optimal management strategy in this age group remains uncertain.  

Purpose

To investigate the 2-year major adverse cardiovascular events (MACE) as the primary outcome in patients aged ≥75 years old presenting with NSTEMI and managed with either invasive or conservative medical therapy in a large teaching hospital in the United Kingdom. 

Method

Baseline data was obtained from electronic clinical records on patients aged ≥ 75 years old who presented with NSTEMI between January 2023 and December 2023. MACE data was obtained in December 2025, comparing outcomes between the two management strategies. 

Results

115 patients were included, (mean age of 81.1±4.4 years) and 45.2% (n=52) were female. 78 patients (67.8%) underwent invasive management, and 37 patients (32.2%) underwent conservative medical management. 

The primary outcome event occurred in 34 patients (43.6%) in the invasive group and 16 patients (43.2%) in the conservative medical management group.

Patients managed with an invasive strategy had a numerically greater survival (854.0 days, 95% CI 776.0-932.0) compared to conservative management (732.7 days, 95% CI 605.7-859.7) but this was not statistically significant (p=0.15). There was no statistically significant difference in repeat invasive angiography and revascularisation between the two groups. 

Conclusion

There is no significant difference in MACE at 2 years in patients ≥75 years old presenting with an NSTEMI and managed with either conservative or invasive strategies. The management of patients in this age group should therefore be individualised. 

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