Data Sheet 1_Invasive treatment strategy for older patients with non-ST-elevation acute coronary syndrome: a systematic review and meta-analysis of randomized controlled trials.pdf

BackgroundThe optimal strategy for managing older patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) is uncertain. We aimed to compare the outcomes of invasive vs. conservative strategies for managing NSTE-ACS in older patients ≥65 years.
MethodsWe systematically searched MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov, up to March 2025. We included randomized controlled trials (RCTs) comparing a routine invasive treatment strategy with conservative management alone in patients ≥65 years old with NTE-ACS. We pooled risk ratios (RRs) and hazard ratios (HRs) under a random-effects model.
ResultsWe included 8 RCTs (3,887 patients). There was no significant difference between invasive and conservative management in the risk of a composite outcome of all-cause mortality or MI (RR 0.91, 95% CI: 0.79, 1.06; HR 0.88, 95% CI: 0.74, 1.05), and all-cause mortality (RR 1.05, 95% CI: 0.93, 1.17; HR 1.03, 95% CI: 0.90, 1.19). Invasive management significantly decreased the risk of MI (RR 0.70, 95% CI: 0.55, 0.89) and revascularization (RR 0.29, 95% CI: 0.21, 0.40). There was no significant difference between the two strategies in the risk of cardiovascular mortality (RR 1.09, 95% CI: 0.87, 1.35) and stroke (RR 0.77; 95% CI: 0.53, 1.12). Invasive management increased the incidence of severe bleeding (RR 1.43; 95% CI: 1.05, 1.94).
ConclusionsAn invasive strategy in older patients with NSTE-ACS decreased the risk of MI and the need for revascularization. Future RCTs need longer follow-ups and should be conducted in ethnically diverse populations to enhance generalizability.
Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD42024629566, PROSPERO CRD42024629566.

背景：非ST段抬高型急性冠状动脉综合征（non-ST-elevation acute coronary syndrome, NSTE-ACS）老年患者的最优管理策略目前尚未明确。本研究旨在比较≥65岁非ST段抬高型急性冠状动脉综合征患者接受有创治疗与保守治疗策略的预后结局。
方法：本研究系统检索了截至2025年3月的MEDLINE、Embase、CENTRAL以及ClinicalTrials.gov数据库。纳入对比≥65岁非ST段抬高型急性冠状动脉综合征患者接受常规有创治疗策略与单纯保守管理的随机对照试验（randomized controlled trials, RCTs），并采用随机效应模型合并相对危险度（risk ratios, RRs）与危险比（hazard ratios, HRs）。
结果：本研究共纳入8项随机对照试验，涉及3887例患者。有创治疗与保守治疗在全因死亡或心肌梗死（myocardial infarction, MI）复合终点的发生风险上无显著差异（RR=0.91，95%置信区间CI：0.79~1.06；HR=0.88，95%CI：0.74~1.05），在全因死亡风险上同样无显著差异（RR=1.05，95%CI：0.93~1.17；HR=1.03，95%CI：0.90~1.19）。有创治疗可显著降低心肌梗死（RR=0.70，95%CI：0.55~0.89）与血运重建（RR=0.29，95%CI：0.21~0.40）的发生风险。两种治疗策略在心血管死亡（RR=1.09，95%CI：0.87~1.35）与卒中（RR=0.77，95%CI：0.53~1.12）的发生风险上无显著差异。有创治疗会升高严重出血的发生风险（RR=1.43，95%CI：1.05~1.94）。
结论：对于≥65岁的非ST段抬高型急性冠状动脉综合征患者，采用有创治疗策略可降低心肌梗死发生风险与血运重建需求。未来的随机对照试验应延长随访时长，并在种族多样化的人群中开展，以提升研究结果的外推性。
系统评价注册信息：https://www.crd.york.ac.uk/PROSPERO/view/CRD42024629566，PROSPERO注册号：CRD42024629566。