Meta-analysis finds invasive therapy reduces MI and revascularization in elderly NSTEMI patients

BACKGROUND: Historically, the elderly population was underrepresented in clinical trials evaluating the optimal treatment for non-ST-segment elevation myocardial infarction (NSTEMI). Therefore, we aimed to compare invasive versus noninvasive strategies for the management of NSTEMI in older adults. METHODS: PubMed, SCOPUS, and Cochrane Central Register of Controlled Trials were screened for studies evaluating medical therapy or invasive revascularization in elderly patients with NSTEMI. Following outcomes were extracted: all-cause mortality, cardiovascular death, fatal or nonfatal MI, repeat coronary revascularization, major adverse cardiovascular events (MACE), bleeding, stroke, noncardiovascular death, and repeat hospitalization for heart failure. Data were pooled using random-effects model to evaluate weighted mean differences and risk ratios with 95% confidence intervals (CIs). This study is registered with PROSPERO, CRD42024622236. RESULTS: Seven studies ( n  = 2997 patients) were included. Patients treated with medical versus invasive therapies showed no significant difference in all-cause mortality (risk ratio: 1.05, 95% CI: 0.94-1.18, P  = 0.37); however, invasive therapies significantly decreased the risk of fatal or nonfatal MI (risk ratio: 0.75, 95% CI: 0.59-0.96, P  = 0.02), repeat coronary revascularizations (risk ratio: 0.29, 95% CI: 0.21-0.40, P  < 0.00001), and risk of MACE (risk ratio: 0.74, 95% CI: 0.61-0.89, P  = 0.002). Lastly, invasive therapies were associated with increased risk of bleeding. CONCLUSION: Invasive therapy, in comparison to medical management, has reduced incidence of fatal or nonfatal MI, MACE, and the need for revascularization; however, no benefit was noted for all-cause and cardiovascular mortality. Age-specific guidelines must be established for the management of NSTEMI among older adults.