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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n\u003Cp id=\u0022p-1\u0022\u003EInvasive intervention following NSTEMI or unstable angina pectoris in the population aged \u2265\u200580 years is controversial. In the After Eighty Study, early invasive intervention proved superior to conservative management in a study population with a mean age of 85 years.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EAfter Eighty Study\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eelderly\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Econservative management\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eearly invasive intervention\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENSTEMI\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Epercutaneous coronary intervention\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Erandomized controlled trial\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Eunstable angina pectoris\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ENCT01255540\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecardiology \u0026amp; cardiovascular medicine clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n\n\u003Cp id=\u0022p-2\u0022\u003EEarly invasive intervention after medical stabilization following NSTEMI or unstable angina pectoris (UAP) was superior to conservative management in participants aged \u2265\u200580 years in the After Eighty Study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT01255540\u0026amp;atom=%2Fspmdc%2F15%2F5%2F21.atom\u0022\u003ENCT01255540\u003C\/a\u003E]. The results were reported by Nicolai Tegn, MD, Rikshospitalet Oslo University Hospital, Oslo, Norway.\u003C\/p\u003E\n\u003Cp id=\u0022p-3\u0022\u003EPatients aged \u2265\u200575 years represent approximately a third of all patients with NSTEMI and UAP [Jokhadar M, Wenger NK. \u003Cem\u003EClin Interv Aging.\u003C\/em\u003E 2009]. However, this population is underrepresented in clinical trials; only 1 previous randomized trial, the Italian Elderly ACS Study [Savonitto S et al. \u003Cem\u003EJACC Cardiovasc Interv.\u003C\/em\u003E 2012], has been conducted exclusively in this age group. The role of invasive management in patients aged \u2265\u200580 years following NSTEMI or UAP is a matter of debate, Prof Tegn said.\u003C\/p\u003E\n\u003Cp id=\u0022p-4\u0022\u003EOf 4187 patients who were screened, 457 patients (mean age 85 years), who were medically stabilized after presenting with a syndrome consistent with NSTEMI\/UAP, were enrolled in the After Eighty Study, an open-label randomized trial, conducted at 17 centers in Norway between 2010 and 2014. The primary reasons for the exclusion from the study were short life expectancy (\u0026lt;\u20051 year), inability to comply with study protocol, refusal to participate, and clinical instability. Participants in the invasively treated group (n\u2005=\u2005229) were 45% women; in the conservatively treated group (n\u2005=\u2005228), 56% of participants were women.\u003C\/p\u003E\n\u003Cp id=\u0022p-5\u0022\u003EBaseline medical history and risk factors were similar between the 2 groups. In both groups, \u0026gt;\u200590% of participants had troponin elevation, 97% were receiving aspirin 75 mg, and \u0026gt;\u200580% were receiving platelet inhibitors, \u03b2-blockers, and statins. The study\u2019s primary end point was a composite of myocardial infarction (MI), need for urgent revascularization, stroke, and death.\u003C\/p\u003E\n\u003Cp id=\u0022p-6\u0022\u003EAmong participants in the invasively treated group, angiography revealed stenosis in \u2265\u20051 vessel in 74% (n\u2005=\u2005165); 49% (n\u2005=\u2005107) underwent percutaneous coronary intervention and 3% (n\u2005=\u20056) underwent coronary artery bypass grafting. In 90% (n\u2005=\u2005198) of participants who underwent revascularization, radial access was used. Participants in both groups received optimal medical treatment.\u003C\/p\u003E\n\u003Cp id=\u0022p-7\u0022\u003EAfter a median follow-up of 1.5 years, 41% (n\u2005=\u200593) of invasively treated participants met the composite primary end point, compared with 61% (n\u2005=\u2005140) of those treated conservatively (rate ratio [RR], 0.48; 95% CI, 0.37 to 0.63; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.00001).\u003C\/p\u003E\n\u003Cp id=\u0022p-8\u0022\u003EMI occurred in 17% of invasively treated participants (n\u2005=\u200539) vs 30% (n\u2005=\u200569) of those treated conservatively (RR, 0.5; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.0003). Urgent revascularization was required in 2% (n\u2005=\u20055) of invasively treated participants vs 11% (n\u2005=\u200524) of those treated conservatively (RR, 0.19; \u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.0001). The composite of death plus MI occurred in 35% (n\u2005=\u200581) of invasively treated participants vs 48% (n\u2005=\u2005109) of those treated conservatively (RR, 0.54; \u003Cem\u003EP\u003C\/em\u003E\u2005\u0026lt;\u2005.0001). The 2 groups did not differ significantly in rates of stroke (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.26), death from any cause (\u003Cem\u003EP\u003C\/em\u003E\u2005=\u2005.53), or bleeding complications (no \u003Cem\u003EP\u003C\/em\u003E values reported).\u003C\/p\u003E\n\u003Cp id=\u0022p-9\u0022\u003EIn summary, in a highly selected randomized cohort with a mean age of 85 years, an early invasive treatment strategy after medical stabilization following NSTEMI or UAP had statistically significantly superior results compared with a conservative management strategy, with no increase in bleeding complications. The radial approach was used in 90% of the study patients.\u003C\/p\u003E\n\u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 SAGE Publications\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/15\/5\/21.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlp62\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}