Patients above 80 years of age with myocardial infarction or unstable angina benefit more from invasive procedures than medication only, according to Nicolai Kloumann Tegn‘s thesis.
Thesis: Invasive versus conservative strategy in the very elderly with acute coronary syndrome
Candidate: Nicolai Kloumann Tegn
Time: September 6, 2019 at 13:00
Place: University of Oslo, Domus Medica: Nye auditorium 13
Link to university website
(1) The After Eighty Study includes 457 clinically stable patients admitted to 16 hospitals in Southern and Eastern Norway with unstable angina or myocardial infarction without ST-elevation (NSTEMI). Half were randomly assigned to recieve invasive treatment in form of coronary angioangraphy and subsequently PCI or coronary artery bypass grafting (CABG) if indicated. The control group received optimal medical treatment at the local hospital.
Invasive treatment reduced the risk of new heart attack, stroke, death and new PCI or CABG during the follow-up period of median 1.5 years. The results – published in The Lancet – indicate that invasive treatment might be particularly effective in preventing myocardial infarction and new revascularizations. The benefit of an invasive treatment strategy was applicable to both women and men, and regardless of whether the patients had diabetes or not. However, for patients above 90 years of age, the researchers could not conclude that an invasive strategy is beneficial.
(2) There was no improvement in quality of life in elderly heart patients one year after invasive treatment. Furthermore, the lack of effect was similar to that observed following optimal medical therapy. The only difference was that those who underwent invasive treatment reported marginally, but statistically significant, less physical pain than those treated with medication only. Tegn and colleagues consider it unlikely that this difference has clinical relevance.
This study includes data from the 273 After Eighty patients who filled out a questionnaire on quality of life one year after treatment.
(1) Tegn, N., Abdelnoor, M., Aaberge, L., Endresen, K., Smith, P., Aakhus, S., Gjertsen, E., Dahl-Hofseth, O. D., Ranhoff, A. H., Gullestad, L., & Bendz, B. (2016). Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. The Lancet, 387(10023), 1057-1065.
(2) Tegn, N., Abdelnoor, M., Aaberge, L., Hylen Ranhoff, A., Endresen, K., Gjertsen, E.,Skårdal, R., Gullestad, L., & Bendz, B. (2017). Health-related quality of life in older patients with acute coronary syndrome randomised to an invasive or conservative strategy. The After Eighty randomised controlled trial. Age and ageing, 47(1), 42-47.
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