000			03227nam a22003497a 4500
008			220926s20222022 xxu||||| |||| 00| 0 eng d
022			_a0146-2806
024			_a10.1016/j.cpcardiol.2022.101304 [doi]
024			_aS0146-2806(22)00201-8 [pii]
040			_aOvid MEDLINE(R)
099			_a35803333
245			_aRoutine Invasive Strategy in Elderly Patients with Non-ST Elevation Acute Coronary Syndrome: An Updated Systematic Review and Meta-analysis of Randomized Trials. [Review]
251			_aCurrent Problems in Cardiology. 47(10):101304, 2022 Jul 05.
252			_aCurr Probl Cardiol. 47(10):101304, 2022 Jul 05.
253			_aCurrent problems in cardiology
260			_c2022
260			_fFY2023
260			_p2022 Jul 05
265			_saheadofprint
266			_d2022-09-26
501			_aAvailable online from MWHC library: 1995 - 2009, Available in print through MWHC library:1999-2007
520			_aInvasive treatment with coronary angiography is preferred approach for patients with non-ST elevation acute coronary syndrome (NSTE-ACS) compared to medical therapy alone. The results from the randomized clinical trials (RCT) that compared the invasive treatment strategy vs. conservative approach in the elderly (>=75 years) with NSTE-ACS has been inconsistent. To compare invasive and conservative strategies in the elderly (>75 years) with NSTE-ACS. We searched PubMed, Cochrane CENTRAL Register and ClinicalTrials.gov (inception through July 10, 2021) for RCTs comparing invasive and conservative strategies in the elderly with NSTE-ACS. We used random-effects model to calculate risk ratio (RR) with 95% confidence interval(CI). A total of 6 RCT including 2,323 patients were included in the meta-analysis. The median follow-up duration was 13.5 months. When invasive approach was compared to conservative strategy, it showed no difference in all-cause mortality in patients aged >=75 years with NSTE-ACS (RR of 0.85; 95% CI 0.70-1.04; P=0.12; I2=0%). There was significant reduction in MI (RR 0.59; 95% CI 0.49 0.71; P < 0.001; I2 = 0%) and unplanned revascularization (RR 0.30, 95% CI 0.17-0.53, P <0.001, I2 = 0%). Invasive strategy was associated with higher risk of major bleeding when compared to conservative treatment (RR 2.12, 95% CI 1.21-3.74, P=0.009, I2 = 0%). Comparison of both strategies showed no significant difference in stroke (RR 0.75; 95% CI 0.38-1.46, P=0.40; I2 = 0%). This updated meta-analysis suggests that in elderly patients (>75 years) with NSTE-ACS, a routine invasive strategy is associated with a reduction in MI and revascularization, while increasing the risk of major bleeding, but without difference in all-cause mortality and stroke. Copyright Published by Elsevier Inc.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Heart & Vascular Institute
657			_aJournal Article
657			_aReview
700			_aBen-Dor, Itsik
790			_aAbusnina W, Al-Abdouh A, Alam M, Algheriani H, Azrin M, Ben-Dor I, Dahal K, Ismayl M, Jimenez E, Lee J, Paul TK, Radaideh Q
856			_uhttps://dx.doi.org/10.1016/j.cpcardiol.2022.101304 _zhttps://dx.doi.org/10.1016/j.cpcardiol.2022.101304
942			_cART _dArticle
999			_c354 _d354