Evidence map›Paper›PMID 38596853›Full record

SynthesisEuropean heart journal2024

Invasive vs. conservative management of older patients with non-ST-elevation acute coronary syndrome: individual patient data meta-analysis.

Christos P Kotanidis, Gregory B Mills, Bjørn Bendz, Erlend S Berg, David Hildick-Smith, Geir Hirlekar, Dejan Milasinovic, Nuccia Morici, Aung Myat, Nicolai Tegn and 6 more

Open access · hybridAbstract readMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in European heart journal, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 4 pooled it
23.7field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 4 syntheses or guidelines pooled it, 59 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Trial
  6. Article
  7. Review
  8. Age-Stratified Mortality Impact of Atrial Fibrillation in Elderly NSTEMI Patients.Journal of cardiovascular development and disease · 2026
    Article
  9. Review
  10. Article
  11. Article
  12. Article
  13. Review
  14. Article
  15. Article
  16. Treatment of non-ST-segment elevation myocardial infarction in the elderly: the SENIOR-RITA trial.European heart journal supplements : journal of the European Society of Cardiology · 2025
    Article
  17. Review
  18. Article
  19. Elderly patients with ACS should not be denied invasive coronary angiography: pros and cons.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2024
    Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors at 10 institutions in 6 countries.

Christos P KotanidisTranslational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK.
Gregory B MillsTranslational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK.ORCID 0000-0002-7981-3594
Bjørn BendzDepartment of Cardiology, Oslo University Hospital, Oslo, Norway.ORCID 0000-0002-1392-6481
Erlend S BergDepartment of Cardiology, Oslo University Hospital, Oslo, Norway.
David Hildick-SmithSussex Cardiac Centre, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.ORCID 0000-0002-1147-1436
Geir HirlekarDepartment of Molecular and Clinical Medicine, Institute of Medicine, Gothenburg University, Gothenburg, Sweden.
Dejan MilasinovicDepartment of Cardiology, University Clinical Center of Serbia, Belgrade, Serbia.ORCID 0000-0002-1528-5147
Nuccia MoriciIRCCS Fondazione Don Carlo Gnocchi, Milan, Italy.ORCID 0000-0003-1070-8857
Aung MyatMedpace UK, London, UK.
Nicolai TegnDepartment of Cardiology, Oslo University Hospital, Oslo, Norway.
Juan SanchisDepartment of Cardiology, Hospital Clinico Universitario, INCLIVA, Universitat de Valencia, CIBER-Cardiovascular, Valencia, Spain.ORCID 0000-0003-0797-8709
Stefano SavonittoClinica San Martino, Malgrate, Italy.
Stefano De ServiDepartment of Molecular Medicine, University of Pavia, Pavia, Italy.
Keith A A FoxCentre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
Stuart PocockLondon School of Hygiene and Tropical Medicine, London, UK.
Vijay KunadianTranslational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor William Leech Building, Newcastle upon Tyne NE2 4HH, UK.ORCID 0000-0003-2975-6971
Newcastle upon Tyne Hospitals NHS Foundation Trust · GBOslo University Hospital · NODon Carlo Gnocchi Foundation · ITLondon School of Hygiene & Tropical Medicine · GBSahlgrenska University Hospital · SEUniversitat de València · ESUniversity Hospitals Sussex NHS Foundation Trust · GBUniversity of Belgrade · RSUniversity of Edinburgh · GBUniversity of Pavia · IT

Funding

British Heart Foundation CS/15/7/31679NIHR
6 · The paper itself

Abstract

BACKGROUND AND

aimsOlder patients with non-ST-elevation acute coronary syndrome (NSTEACS) are less likely to receive guideline-recommended care including coronary angiography and revascularization. Evidence-based recommendations regarding interventional management strategies in this patient cohort are scarce. This meta-analysis aimed to assess the impact of routine invasive vs. conservative management of NSTEACS by using individual patient data (IPD) from all available randomized controlled trials (RCTs) including older patients.

methodsMEDLINE, Web of Science and Scopus were searched between 1 January 2010 and 11 September 2023. RCTs investigating routine invasive and conservative strategies in persons >70 years old with NSTEACS were included. Observational studies or trials involving populations outside the target range were excluded. The primary endpoint was a composite of all-cause mortality and myocardial infarction (MI) at 1 year. One-stage IPD meta-analyses were adopted by use of random-effects and fixed-effect Cox models. This meta-analysis is registered with PROSPERO (CRD42023379819).

resultsSix eligible studies were identified including 1479 participants. The primary endpoint occurred in 181 of 736 (24.5%) participants in the invasive management group compared with 215 of 743 (28.9%) participants in the conservative management group with a hazard ratio (HR) from random-effects model of 0.87 (95% CI 0.63-1.22; P = .43). The hazard for MI at 1 year was significantly lower in the invasive group compared with the conservative group (HR from random-effects model 0.62, 95% CI 0.44-0.87; P = .006). Similar results were seen for urgent revascularization (HR from random-effects model 0.41, 95% CI 0.18-0.95; P = .037). There was no significant difference in mortality.

conclusionsNo evidence was found that routine invasive treatment for NSTEACS in older patients reduces the risk of a composite of all-cause mortality and MI within 1 year compared with conservative management. However, there is convincing evidence that invasive treatment significantly lowers the risk of repeat MI or urgent revascularisation. Further evidence is needed from ongoing larger clinical trials.

Indexed as

Acute Coronary SyndromeConservative TreatmentPercutaneous Coronary InterventionAgedCoronary AngiographyFemaleHumansMyocardial RevascularizationNon-ST Elevated Myocardial InfarctionRandomized Controlled Trials as TopicAcute coronary syndromeCoronary angiographyMyocardial infarctionOlder adultsPercutaneous coronary intervention

Identifiers

PMID38596853
PMCPMC11177715
OpenAlexW4394692676

What Socratic holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.