Invasive versus conservative management of older patients with non-ST- elevation acute coronary syndrome: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Background The benefits of conservative treatment versus invasive strategies for elderly patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) remain ambiguous. Consequently, this systematic review and meta-analysis aimed to assess and compare the effects of invasive versus conservative treatment strategies in elderly patients diagnosed with NSTEACS. Methods We searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from inception to October 2024 to identify RCTs comparing invasive versus conservative management in elderly patients with non-ST-elevation acute coronary syndrome. The primary outcome was all-cause mortality at 1 year, with secondary outcome including myocardial infarction (MI). Results Seven trials (2997 patients) reported primary outcome data, with six also providing data on myocardial infarction. At 1-year follow-up, there was no difference in all-cause mortality between the invasive treatment group and the conservative treatment group (RR 1.05, 95%CI 0.94 to 1.18, I ²  = 0%) After a one-year follow-up, but invasive treatment reduce the risk of myocardial infarction (RR 0.74, 95%CI 0.57 to 0.95, I ²  = 38%). Conclusion In the elderly with Non–ST-segment elevation myocardial infarction, invasive treatment did not improve all-cause mortality at 1-year follow-up compared to conservative management. However, it was found to significantly lower the risk of myocardial infarction.