Invasive vs. conservative management of older patients with non-ST-elevation acute coronary syndrome: individual patient data meta-analysis

The global population aged over 65 years is forecast to double to 1.5 billion people by 2050.1 Ischaemic heart disease is the leading cause of death worldwide, with the greatest mortality burden afflicting older adults.2 International treatment guidelines recommend coronary angiography with subsequent revascularization if indicated in higher-risk patients following non-ST-elevation acute coronary syndrome (NSTEACS),3 yet evidence-based recommendations for the care of older patients with NSTEACS are scarce—this is highlighted as a significant gap in evidence.4–6 This patient group is at greatest baseline risk of in-hospital death, ischaemic events, and bleeding, yet paradoxically is under-represented in clinical trials of acute coronary syndrome treatment strategy and least likely to receive evidence-based medications, coronary angiography, and revascularization.


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