Dicle Medical Journal

1300-2945 1308-9889

Dicle University

10.5798/dicletip.1906522

Health Care Administration Medical Education Health Services and Systems (Other)

Sağlık Kurumları Yönetimi Tıp Eğitimi Sağlık Hizmetleri ve Sistemleri (Diğer)

80 Yaş üzeri ST Segment Yükselmesiz Miyokart Enfarktüsü Hastalarında İnvaziv ve Konservatif Tedavinin Hastane içi Mortalite üzerine etkilerinin karşılaştırılması

Comparison of Invasive and Conservative Treatment Strategies on In-Hospital Mortality in Patients Aged 80 Years And Older With Non-ST-Elevation Myocardial Infarction

Unkun

Tuba

SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, İSTANBUL KARTAL KOŞUYOLU YÜKSEK İHTİSAS SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ Erdal

Simay

Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi

03 10 2026

53 1 241 251 12 20 2025 03 01 2026

2003

Dicle Medical Journal

Amaç: Bu çalışmada, 80 yaş ve üzeri ST-segment elevasyonsuz miyokard enfarktüsü (NSTEMI) hastalarında invaziv ve konservatif tedavi stratejilerinin hastane içi mortalite üzerine etkisi araştırıldı.Yöntemler: Ocak 2019 – Mayıs 2025 tarihleri arasında Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi’nde NSTEMI tanısıyla yatırılan ≥80 yaşındaki hastalar retrospektif olarak değerlendirildi. Dahil edilme ve dışlama kriterleri uygulandıktan sonra 148 hasta çalışmaya alındı. Hastalar tedavi stratejisine göre invaziv ve konservatif olarak iki gruba ayrıldı. Demografik, klinik, ekokardiyografik ve laboratuvar bulguları ile hastane içi sonlanımlar karşılaştırıldı.Bulgular: Toplam 148 hasta çalışmaya dâhil edildi; bunların 90’ı (%62,1) invaziv, 58’i (%37,9) konservatif tedavi grubundaydı. Tüm kohortun medyan yaşı 86 (80–105) yıl olup, %44,6’sı kadındı. Konservatif grup, invaziv gruba göre daha ileri yaşta (p

Objective: This study aimed to investigate the impact of invasive versus conservative treatment strategies on in-hospital mortality in patients aged ≥80 years with non-ST-segment elevation myocardial infarction (NSTEMI).Methods: Between January 2019 and May 2025, patients aged ≥80 years who were hospitalized with a diagnosis of NSTEMI at Koşuyolu High Specialization Training and Research Hospital were retrospectively evaluated. Following the application of inclusion and exclusion criteria, 148 patients were enrolled. Patients were divided into invasive and conservative groups according to treatment strategy. Demographic, clinical, echocardiographic, and laboratory parameters, as well as in-hospital outcomes, were compared.Results: A total of 148 patients were included in the study, with 90 (62.1%) in the invasive treatment group and 58 (37.9%) in the conservative group. The median age of the patients was 86 years, and 44.6% were female. Patients in the conservative group were significantly older (p

NSTEMI ileri yaş invaziv tedavi konservatif tedavi mortalite

NSTEMI elderly invasive strategy conservative strategy in-hospital mortality.

1.GBD 2016 Causes of Death Collaborators. Global,regional, and national age-sex specific mortality for264 causes of death, 1980-2016: a systematic analysisfor the Global Burden of Disease Study 2016. Lancet.2017;390:1151-210.

2.Veerasamy M, Edwards R, Ford G, et al. Acutecoronary syndrome among older patients: a review.Cardiol Rev. 2015;23(1):26-32.

3.Mills GB, Ratcovich H, Adams-Hall J, et al. Is thecontemporary care of the older persons with acutecoronary syndrome evidence-based? Eur Heart J Open.2022;2(1):oeab044.

4.Lopes RD, White JA, Tricoci P, et al. Age, treatment,and outcomes in high-risk non-ST-segment elevationacute coronary syndrome patients: insights from theEARLY ACS trial. Int J Cardiol. 2013;167:2580-7.

5.Kayani WT, Khan MR, Deshotels MR, Jneid H.Challenges and controversies in the management ofACS in elderly patients. Curr Cardiol Rep. 2020;22:51.

6.Sanchis J, Núñez E, Barrabés JA, et al. Randomizedcomparison between the invasive and conservativestrategies in comorbid elderly patients with non-STelevation myocardial infarction. Eur J Intern Med.2016;35:89-94.

7.Savonitto S, Cavallini C, Petronio AS, et al. Earlyaggressive versus initially conservative treatment inelderly patients with non-ST-segment elevation acutecoronary syndrome: a randomized controlled trial.JACC Cardiovasc Interv. 2012;5(9):906-16.

8.Rao SV, O'Donoghue ML, Ruel M, et al. 2025ACC/AHA/ACEP/NAEMSP/SCAI guideline for themanagement of patients with acute coronarysyndromes. Circulation. 2025;151(13):e771-e862.

9.Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESCguidelines for the management of acute coronarysyndromes. Eur Heart J. 2023;44(38):3720-826.

10.Tahhan AS, Vaduganathan M, Greene SJ, et al.Enrollment of older patients, women, and racial/ethnicminority groups in contemporary acute coronarysyndrome clinical trials: a systematic review. JAMACardiol. 2020;5:714-22.

11.Invasive compared with non-invasive treatment inunstable coronary-artery disease: FRISC II prospectiverandomised multicentre study. FRagmin and FastRevascularisation during InStability in Coronaryartery disease Investigators. Lancet. 1999;354:708-15.

12.Tegn N, Abdelnoor M, Aaberge L, et al. Invasiveversus conservative strategy in patients aged 80 yearsor older with non-ST elevation myocardial infarctionor unstable angina pectoris (After Eighty study): anopen-label randomised controlled trial. Lancet.2016;387:1057-65.

13.Mehran R, Rao SV, Bhatt DL, et al. Standardizedbleeding definitions for cardiovascular clinical trials: aconsensus report from the Bleeding AcademicResearch Consortium. Circulation.2011;123(23):2736-47.

14.Stacul F, van der Molen AJ, Reimer P, et al. Contrastinduced nephropathy: updated ESUR Contrast MediaSafety Committee guidelines. Eur Radiol.2011;21:2527-41.

15.Mohammed NM, Mahfouz A, Achkar K, Rafie IM,Hajar R. Contrast-induced nephropathy. Heart Views.2013;14:106-16.

16. Ratcovich H, Beska B, Mills G, et al. Five-year clinicaloutcomes in patients with frailty aged ≥75 years with non-ST elevation acute coronary syndrome undergoing invasive management. Eur Heart J Open. 2022;2:oeac035.

17.Gu SZ, Qiu W, Batty JA, et al. Coronary artery lesionphenotype in frail older patients with non-ST-elevation acute coronary syndrome undergoinginvasive care. EuroIntervention. 2019;15:e261-8.

18.Batty J, Qiu W, Gu S, et al. One-year clinicaloutcomes in older patients with non-ST elevation acutecoronary syndrome undergoing coronaryangiography: an analysis of the ICON1 study. Int JCardiol. 2019;274:45-51.

19.Sinclair H, Batty JA, Qiu W, Kunadian V. Engagingolder patients in cardiovascular research:observational analysis of the ICON-1 study. OpenHeart. 2016;3:e000436.

20.Rosengren A, Wallentin L, Simoons M, et al. Age,clinical presentation, and outcome of acute coronarysyndromes in the Euroheart acute coronary syndromesurvey. Eur Heart J. 2006;27:789-95.

21.Fox KA, Clayton TC, Damman P, et al. Long-termoutcome of a routine versus selective invasive strategyin patients with non-ST-segment elevation acutecoronary syndrome: a meta-analysis of individualpatient data. J Am Coll Cardiol. 2010;55:2435-45.

22.Kolte D, Khera S, Palaniswamy C, et al. Earlyinvasive versus initial conservative treatmentstrategies in octogenarians with UA/NSTEMI. Am JMed. 2013;126:1076-83.

23.Devlin G, Gore JM, Elliott J, et al. Management and6-month outcomes in elderly and very elderly patientswith high-risk non-ST-elevation acute coronarysyndromes: the GRACE registry. Eur Heart J.2008;29:1275-82.

24.Bauer T, Koeth O, Junger C, et al. Effect of aninvasive strategy on in-hospital outcome in elderlypatients with non-ST-elevation myocardial infarction.Eur Heart J. 2007;28:2873-8.

25.Işık F, İnci Ü, Akyüz A, Cil H. ST segmentyükselmesiz akut koroner sendromlu yaşlı hastalardagirişimsel tedavi ile konservatif tedavinin altı aylıkdönemde mortalite üzerine etkilerininkarşılaştırılması. Dicle Med J. 2021;48(3):529-36.

26.de Belder A, Myat A, Blaxill J, et al.Revascularisation or medical therapy in elderlypatients with acute anginal syndromes: the RINCALrandomised trial. EuroIntervention. 2021;17(1):67-74.

27.Hirlekar G, Libungan B, Karlsson T, et al.Percutaneous coronary intervention in the veryelderly with NSTE-ACS: the randomized 80+ study.Scand Cardiovasc J. 2020;54(5):315-21.

28.Hamed M, Gabr EM, Harmouch W, et al. Invasiveversus conservative management among older adultpatients with non-ST-segment-elevation myocardialinfarction: a meta-analysis of randomized controlledtrials. J Am Heart Assoc. 2025;14(14):e039601.

29.Kunadian V, Mossop H, Shields C et al. Invasivetreatment strategy for older patients with myocardialinfarction. N Engl J Med. 2024;391:1673-84.

30.Murad K, Kitzman DW. Frailty and multiplecomorbidities in the elderly patient with heart failure:implications for management. Heart Fail Rev.2012;17:581-8.

31.Ersoy A, Erturk T, Guven BB, et al. Effects of age andcomorbidities on prognosis and mortality in geriatricpatient groups in intensive care. Niger J Clin Pract.2023;26(2):145-52.

32.Doll JA, Hira RS, Kearney KE, et al. Management ofpercutaneous coronary intervention complications:algorithms from the 2018 and 2019 Seattlepercutaneous coronary intervention complicationsconference. Circ Cardiovasc Interv.2020;13(6):e008962

33.Patel VG, Brayton KM, Tamayo A, et al.Angiographic success and procedural complications inpatients undergoing percutaneous coronary chronictotal occlusion interventions: a weighted meta-analysis of 18,061 patients from 65 studies. JACCCardiovasc Interv. 2013;6(2):128-36.

34.Lattuca B, Cayla G, Silvain J, et al. Bleeding in theelderly: risk factors and impact on clinical outcomesafter an acute coronary syndrome, a sub-study of therandomized ANTARCTIC trial. Am J Cardiovasc Drugs.2021;21(6):681-91.

35.Htwe TH, Mushtaq A, Robinson SB, Rosher RB,Khardori N. Infection in the elderly. Infect Dis ClinNorth Am. 2007;21(3):711-43.

36.Conti M, Merlani P, Ricou B. Prognosis and qualityof life of elderly patients after intensive care. SwissMed Wkly. 2012;142:w13671.