Invasive versus Conservative Strategies in the Elderly with ACS

This was a systematic review and meta-analysis that compared invasive to conservative strategy for older patients presenting with ACS.

I have previously reviewed guidelines on the Management of Cardiogenic Shock in the Elderly.

What They Did

Eligible studies were of patients > 70 yo who presented with AMI to receive:

1. Early invasive coronary angiography or subsequent PCI or coronary artery bypass grafting within 72 hours or
2. Conservative management ie., medical therapy. Coronary angiography is only permitted in emergent situations
3. Trials that included thrombolytic therapy in the control arm were included in exploratory sensitivity analyses.

The Study

Reddy RK et al. Early Invasive or Conservative Strategies for Older Patients With Acute Coronary Syndromes. A Meta-Analysis. JAMA Intern Med. doi:10.1001/jamainternmed.2025.2058