{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T22:27:49Z","timestamp":1782512869545,"version":"3.54.5"},"reference-count":30,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2025,3,26]],"date-time":"2025-03-26T00:00:00Z","timestamp":1742947200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Non\u2010ST segment elevation acute coronary syndromes (NSTE\u2010ACS) are a common cause of hospital admission in older patients. Our study aims to synthesize the available evidence from randomized controlled trials (RCTs) to compare clinical outcomes with invasive versus conservative medical management in this population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A literature search of online databases including PubMed\/MEDLINE, Embase, and the Cochrane Library was conducted from inception to September 1, 2024. The search aimed to identify RCTs that reported clinical outcomes with invasive versus conservative strategies in older patients (\u2265\u200970\u2009years) with NSTE\u2010ACS. The risk ratios (RRs) were used as summary estimates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven RCTs with 2998 patients were included; 1490 patients in the invasive group and 1508 patients in the conservatively managed group. The pooled analysis demonstrated no statistically significant difference between the two strategies for the risk of all\u2010cause death (RR: 1.03, 95% CI: 0.92\u20131.15), cardiovascular death (RR: 1.04, 95% CI: 0.82\u20131.33), stroke (RR: 0.78, 95% CI: 0.53\u20131.15), and major bleeding (RR: 1.23, 95% CI: 0.90\u20131.69). However, the invasive strategy was associated with a significantly reduced risk of myocardial infarction (RR: 0.74, 95% CI: 0.57\u20130.96) and unplanned revascularization (RR: 0.29, 95% CI: 0.21\u20130.40) compared to the conservative strategy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In older patients with NSTE\u2010ACS, an invasive strategy reduces the risk of repeat myocardial infarction and unplanned revascularization without a significant increase in stroke or major bleeding. There was no associated reduction in all\u2010cause or cardiovascular mortality with the invasive strategy compared to conservative management.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.19447","type":"journal-article","created":{"date-parts":[[2025,3,29]],"date-time":"2025-03-29T04:13:27Z","timestamp":1743221607000},"page":"2238-2246","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Invasive Versus Conservative Treatment Strategy in Older Patients With Non\u2010\n                    <scp>ST<\/scp>\n                    Segment Elevation Acute Coronary Syndromes: A Meta\u2010Analysis of Randomized Controlled Trials"],"prefix":"10.1111","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9872-8224","authenticated-orcid":false,"given":"Mushood","family":"Ahmed","sequence":"first","affiliation":[{"name":"Rawalpindi Medical University  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Areeba","family":"Ahsan","sequence":"additional","affiliation":[{"name":"Foundation University Medical College  Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aimen","family":"Shafiq","sequence":"additional","affiliation":[{"name":"Dow University of Health Sciences  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6355-3907","authenticated-orcid":false,"given":"Tallal Mushtaq","family":"Hashmi","sequence":"additional","affiliation":[{"name":"Rawalpindi Medical University  Rawalpindi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raheel","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Cardiology Royal Brompton Hospital  London UK"},{"name":"National Heart and Lung Institute Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahboob","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farhan","family":"Shahid","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology Queen Elizabeth Hospital  Birmingham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamal S.","family":"Rana","sequence":"additional","affiliation":[{"name":"Division of Cardiology Kaiser Permanente Northern California  Oakland California USA"},{"name":"Division of Research Kaiser Permanente Northern California  Oakland California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamas A.","family":"Mamas","sequence":"additional","affiliation":[{"name":"Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University  Keele UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregg C.","family":"Fonarow","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Ahmanson\u2010UCLA Cardiomyopathy Center University of California Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,26]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/CRD.0000000000000016"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/ehjopen\/oeab044"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11886-020-01298-x"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2016.07.003"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2012.06.008"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa575"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2014.09.017"},{"issue":"21","key":"e_1_2_14_9_1","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.124.036151","article-title":"Invasive Versus Conservative Strategy in Older Adults \u226575\u2009Years of Age With Non\u2010ST\u2010Segment\u2010Elevation Acute Coronary Syndrome: A Systematic Review and Meta\u2010Analysis of Randomized Controlled Trials","volume":"13","author":"Rout A.","year":"2024","journal-title":"Journal of the American Heart Association"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2022.10.011"},{"key":"e_1_2_14_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehae151"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2407791"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898"},{"issue":"4","key":"e_1_2_14_15_1","first-page":"719","article-title":"Statistical Aspects of the Analysis of Data From Retrospective Studies of Disease","volume":"22","author":"Mantel N.","year":"1959","journal-title":"Journal of the National Cancer Institute"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.6028\/jres.087.022"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/9781119536604.ch10"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/14017431.2020.1781243"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)01166-6"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-20-00975"},{"key":"e_1_2_14_21_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2023.0047"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/ccd.30448"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10741-011-9258-y"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.4103\/njcp.njcp_1628_21"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.120.008962"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2012.10.011"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-12-804766-8.00021-2"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.1005614"},{"key":"e_1_2_14_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40256-021-00468-8"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2007.07.006"},{"key":"e_1_2_14_31_1","doi-asserted-by":"crossref","DOI":"10.4414\/smw.2012.13671","article-title":"Prognosis and Quality of Life of Elderly Patients After Intensive Care","volume":"142","author":"Conti M.","year":"2012","journal-title":"Swiss Medical Weekly"}],"container-title":["Journal of the American Geriatrics Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jgs.19447","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T13:17:01Z","timestamp":1762175821000},"score":1,"resource":{"primary":{"URL":"https:\/\/agsjournals.onlinelibrary.wiley.com\/doi\/10.1111\/jgs.19447"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,26]]},"references-count":30,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2025,7]]}},"alternative-id":["10.1111\/jgs.19447"],"URL":"https:\/\/doi.org\/10.1111\/jgs.19447","archive":["Portico"],"relation":{},"ISSN":["0002-8614","1532-5415"],"issn-type":[{"value":"0002-8614","type":"print"},{"value":"1532-5415","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,26]]},"assertion":[{"value":"2024-10-17","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-02-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-03-26","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}