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Effects of age on long-term outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes: a collaborative analysis of individual data from the FRISC II - ICTUS - RITA-3 (FIR) trials.
Heart. 2012 Feb; 98(3):207-13.H

Abstract

OBJECTIVE

To perform a patient-pooled analysis of a routine invasive versus a selective invasive strategy in elderly patients with non-ST segment elevation acute coronary syndrome.

METHODS

A meta-analysis was performed of patient-pooled data from the FRISC II-ICTUS-RITA-3 (FIR) studies. (Un)adjusted HRs were calculated by Cox regression, with adjustments for variables associated with age and outcomes. The main outcome was 5-year cardiovascular death or myocardial infarction (MI) following routine invasive versus selective invasive management.

RESULTS

Regarding the 5-year composite of cardiovascular death or MI, the routine invasive strategy was associated with a lower hazard in patients aged 65-74 years (HR 0.72, 95% CI 0.58 to 0.90) and those aged ≥75 years (HR 0.71, 95% CI 0.55 to 0.91), but not in those aged <65 years (HR 1.11, 95% CI 0.90 to 1.38), p=0.001 for interaction between treatment strategy and age. The interaction was driven by an excess of early MIs in patients <65 years of age; there was no heterogeneity between age groups concerning cardiovascular death. The benefits were smaller for women than for men (p=0.009 for interaction). After adjustment for other clinical risk factors the HRs remained similar.

CONCLUSION

The current analysis of the FIR dataset shows that the long-term benefit of the routine invasive strategy over the selective invasive strategy is attenuated in younger patients aged <65 years and in women by the increased risk of early events which seem to have no consequences for long-term cardiovascular mortality. No other clinical risk factors were able to identify patients with differential responses to a routine invasive strategy. Trial registration http://www.controlled-trials.com/ISRCTN82153174 (ICTUS), http://www.controlled-trials.com/ISRCTN07752711 (RITA-3).

Authors+Show Affiliations

Department of Cardiology, Academic Medical Center-University of Amsterdam, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

21930723

Citation

Damman, Peter, et al. "Effects of Age On Long-term Outcomes After a Routine Invasive or Selective Invasive Strategy in Patients Presenting With non-ST Segment Elevation Acute Coronary Syndromes: a Collaborative Analysis of Individual Data From the FRISC II - ICTUS - RITA-3 (FIR) Trials." Heart (British Cardiac Society), vol. 98, no. 3, 2012, pp. 207-13.
Damman P, Clayton T, Wallentin L, et al. Effects of age on long-term outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes: a collaborative analysis of individual data from the FRISC II - ICTUS - RITA-3 (FIR) trials. Heart. 2012;98(3):207-13.
Damman, P., Clayton, T., Wallentin, L., Lagerqvist, B., Fox, K. A., Hirsch, A., Windhausen, F., Swahn, E., Pocock, S. J., Tijssen, J. G., & de Winter, R. J. (2012). Effects of age on long-term outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes: a collaborative analysis of individual data from the FRISC II - ICTUS - RITA-3 (FIR) trials. Heart (British Cardiac Society), 98(3), 207-13. https://doi.org/10.1136/heartjnl-2011-300453
Damman P, et al. Effects of Age On Long-term Outcomes After a Routine Invasive or Selective Invasive Strategy in Patients Presenting With non-ST Segment Elevation Acute Coronary Syndromes: a Collaborative Analysis of Individual Data From the FRISC II - ICTUS - RITA-3 (FIR) Trials. Heart. 2012;98(3):207-13. PubMed PMID: 21930723.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of age on long-term outcomes after a routine invasive or selective invasive strategy in patients presenting with non-ST segment elevation acute coronary syndromes: a collaborative analysis of individual data from the FRISC II - ICTUS - RITA-3 (FIR) trials. AU - Damman,Peter, AU - Clayton,Tim, AU - Wallentin,Lars, AU - Lagerqvist,Bo, AU - Fox,Keith A A, AU - Hirsch,Alexander, AU - Windhausen,Fons, AU - Swahn,Eva, AU - Pocock,Stuart J, AU - Tijssen,Jan G P, AU - de Winter,Robbert J, Y1 - 2011/09/19/ PY - 2011/9/21/entrez PY - 2011/9/21/pubmed PY - 2012/2/22/medline SP - 207 EP - 13 JF - Heart (British Cardiac Society) JO - Heart VL - 98 IS - 3 N2 - OBJECTIVE: To perform a patient-pooled analysis of a routine invasive versus a selective invasive strategy in elderly patients with non-ST segment elevation acute coronary syndrome. METHODS: A meta-analysis was performed of patient-pooled data from the FRISC II-ICTUS-RITA-3 (FIR) studies. (Un)adjusted HRs were calculated by Cox regression, with adjustments for variables associated with age and outcomes. The main outcome was 5-year cardiovascular death or myocardial infarction (MI) following routine invasive versus selective invasive management. RESULTS: Regarding the 5-year composite of cardiovascular death or MI, the routine invasive strategy was associated with a lower hazard in patients aged 65-74 years (HR 0.72, 95% CI 0.58 to 0.90) and those aged ≥75 years (HR 0.71, 95% CI 0.55 to 0.91), but not in those aged <65 years (HR 1.11, 95% CI 0.90 to 1.38), p=0.001 for interaction between treatment strategy and age. The interaction was driven by an excess of early MIs in patients <65 years of age; there was no heterogeneity between age groups concerning cardiovascular death. The benefits were smaller for women than for men (p=0.009 for interaction). After adjustment for other clinical risk factors the HRs remained similar. CONCLUSION: The current analysis of the FIR dataset shows that the long-term benefit of the routine invasive strategy over the selective invasive strategy is attenuated in younger patients aged <65 years and in women by the increased risk of early events which seem to have no consequences for long-term cardiovascular mortality. No other clinical risk factors were able to identify patients with differential responses to a routine invasive strategy. Trial registration http://www.controlled-trials.com/ISRCTN82153174 (ICTUS), http://www.controlled-trials.com/ISRCTN07752711 (RITA-3). SN - 1468-201X UR - https://www.unboundmedicine.com/medline/citation/21930723/Effects_of_age_on_long_term_outcomes_after_a_routine_invasive_or_selective_invasive_strategy_in_patients_presenting_with_non_ST_segment_elevation_acute_coronary_syndromes:_a_collaborative_analysis_of_individual_data_from_the_FRISC_II___ICTUS___RITA_3__FIR__trials_ L2 - https://heart.bmj.com/lookup/pmidlookup?view=long&amp;pmid=21930723 DB - PRIME DP - Unbound Medicine ER -