Abstract 14316: Comparison of Early Invasive versus Initial Conservative Treatment Strategies in Octogenarians With Unstable Angina/Non-ST-Elevation Myocardial Infarction
Background: Previous studies have demonstrated improved outcomes with an early invasive strategy in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI). However, there is lack of data for patients ≥80 years of age in these studies.
Objectives: To compare outcomes (in-hospital mortality, acute ischemic stroke, intracranial hemorrhage, length of stay and total hospital cost) in octogenarians with UA/NSTEMI undergoing early invasive versus initial conservative treatment.
Methods: We used the 2003-2010 Nationwide Inpatient Sample databases to identify all patients aged ≥80 years hospitalized with UA/NSTEMI. Patients were divided into 2 groups - initial conservative and early invasive strategy (coronary angiography within 48 hours of admission, with or without revascularization). Multivariable logistic regression was used to compare outcomes between the 2 treatment groups.
Results: Among 968,541 octogenarians with UA/NSTEMI, 161,640 (16.7%) were managed using an early invasive strategy and 806,902 (83.3%) using an initial conservative approach. Patients in the early invasive group were more likely to be younger, males, white, and had a higher prevalence of smoking, dyslipidemia, obesity, hypertension, known coronary artery disease, carotid artery disease and peripheral vascular disease. Compared to initial conservative strategy, the early invasive strategy was associated with lower in-hospital mortality (4.7% vs. 8.6%, p<0.001). When adjusted for confounding variables, in-hospital mortality remained significantly lower in patients in the early invasive group (adjusted OR 0.76, 95% CI 0.74-0.78). Early invasive strategy was also associated with lower rates of acute ischemic stroke (adjusted OR 0.63, 95% CI 0.60-0.66) and intracranial hemorrhage (adjusted OR 0.60, 95% CI 0.510.70), shorter average length of stay (5.3 vs. 5.8 days, p<0.001), but higher total hospital cost ($23,584 vs. $13,278).
Conclusion: Compared to initial conservative strategy, an early invasive strategy in octogenarians presenting with UA/NSTEMI is associated with lower in-hospital mortality, acute ischemic stroke and intracranial hemorrhage as well as shorter length of stay, but higher total hospital cost.
- © 2013 by American Heart Association, Inc.