{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:13:12Z","timestamp":1760238792107,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2022,8,16]],"date-time":"2022-08-16T00:00:00Z","timestamp":1660608000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Research of Korea Centers for Disease Control and Prevention","award":["2016-ER6304-02"],"award-info":[{"award-number":["2016-ER6304-02"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>We evaluated the 3-year clinical outcomes of early invasive (EI) and delayed invasive (DI) strategies in older and younger adults with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing successful new-generation drug-eluting stent (DES) implantation to reflect current real-world practice. Overall, 4513 patients with NSTEMI were recruited from the Korea Acute Myocardial Infarction Registry-National Institute of Health and divided into two groups according to age: group A (age \u2265 65 years, n = 2253) and group B (age &lt; 65 years, n = 2260). These two groups were further divided into two subgroups: group EI (A1 and B1) and DI (A2 and B2). The primary clinical outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCEs), defined as all-cause death, recurrent MI (re-MI), any repeat coronary revascularization, or stroke. The secondary clinical outcome was definite or probable stent thrombosis (ST). In both groups A and B, after multivariable-adjusted and propensity score-adjusted analyses, MACCE (group A, p = 0.137 and p = 0.255, respectively; group B, p = 0.171 and p = 0.135, respectively), all-cause death, cardiac death (CD), non-CD, re-MI, any repeat revascularization, stroke, and ST rates were similar between the EI and DI groups. When including only those with complex lesions, the primary and secondary clinical outcomes were not significantly different between the EI and DI groups. In the era of new-generation DESs, major clinical outcomes were not significantly different between the EI and DI strategies in both older and younger adults with NSTEMI.<\/jats:p>","DOI":"10.3390\/jcm11164780","type":"journal-article","created":{"date-parts":[[2022,8,16]],"date-time":"2022-08-16T23:44:25Z","timestamp":1660693465000},"page":"4780","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Comparison of 3-Year Outcomes between Early and Delayed Invasive Strategies in Older and Younger Adults with Non-ST-Segment Elevation Myocardial Infarction Undergoing New-Generation Drug-Eluting Stent Implantation"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9669-3598","authenticated-orcid":false,"given":"Yong Hoon","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9990-6843","authenticated-orcid":false,"given":"Ae-Young","family":"Her","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon 24289, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seung-Woon","family":"Rha","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cheol Ung","family":"Choi","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Byoung Geol","family":"Choi","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute, Korea University College of Medicine, Seoul 02841, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji Bak","family":"Kim","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Soohyung","family":"Park","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5187-8310","authenticated-orcid":false,"given":"Dong Oh","family":"Kang","sequence":"additional","affiliation":[{"name":"Cardiovascular Center, Korea University Guro Hospital, Seoul 08308, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ji Young","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Nowon Eulji Medical Center, Eulji University, Seoul 01830, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang-Ho","family":"Park","sequence":"additional","affiliation":[{"name":"Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Myung Ho","family":"Jeong","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Cardiovascular Center, Chonnam National University Hospital, Gwangju 61469, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2165","DOI":"10.1056\/NEJMoa0807986","article-title":"Early versus delayed invasive intervention in acute coronary syndromes","volume":"360","author":"Mehta","year":"2009","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2435","DOI":"10.1016\/j.jacc.2010.03.007","article-title":"Long-term outcome of a routine versus selective invasive strategy in patients with non-ST-segment elevation acute coronary syndrome a meta-analysis of individual patient data","volume":"55","author":"Fox","year":"2010","journal-title":"J. Am. Coll. Cariol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2741","DOI":"10.1161\/CIRCULATIONAHA.118.037152","article-title":"Early Versus Standard Care Invasive Examination and Treatment of Patients With Non-ST-Segment Elevation Acute Coronary Syndrome","volume":"138","author":"Kofoed","year":"2018","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1016\/S0140-6736(17)31490-3","article-title":"Optimal timing of an invasive strategy in patients with non-ST-elevation acute coronary syndrome: A meta-analysis of randomised trials","volume":"390","author":"Jobs","year":"2017","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1016\/j.jcin.2016.09.017","article-title":"Timing of Coronary Invasive Strategy in Non-ST-Segment Elevation Acute Coronary Syndromes and Clinical Outcomes: An Updated Meta-Analysis","volume":"9","author":"Bonello","year":"2016","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1093\/eurheartj\/ehaa575","article-title":"2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation","volume":"42","author":"Collet","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e139","DOI":"10.1016\/j.jacc.2014.09.017","article-title":"2014 AHA\/ACC Guideline for the Management of Patients with Non-ST-Elevation Acute Coronary Syndromes: A report of the American College of Cardiology\/American Heart Association Task Force on Practice Guidelines","volume":"64","author":"Amsterdam","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1253\/circj.CJ-16-0061","article-title":"Multicenter Cohort Study of Acute Myocardial Infarction in Korea-Interim Analysis of the Korea Acute Myocardial Infarction Registry-National Institutes of Health Registry","volume":"80","author":"Kim","year":"2016","journal-title":"Circ. J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1136\/bmj.326.7399.1137","article-title":"ABC of interventional cardiology: Percutaneous coronary intervention. II: The procedure","volume":"326","author":"Grech","year":"2003","journal-title":"BMJ"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1016\/j.ahj.2009.04.004","article-title":"Validity of a risk-prediction tool for hospital mortality: The Global Registry of Acute Coronary Events","volume":"157","author":"Pieper","year":"2009","journal-title":"Am. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.jcin.2019.01.227","article-title":"Impact of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention on Long-Term Clinical Outcomes in Patients Undergoing Complex Procedures","volume":"12","author":"Choi","year":"2019","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"213","DOI":"10.1093\/eurheartj\/ehx419","article-title":"2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"39","author":"Valgimigli","year":"2018","journal-title":"Eur. Heart J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2064","DOI":"10.1161\/STR.0b013e318296aeca","article-title":"An updated definition of stroke for the 21st century: A statement for healthcare professionals from the American Heart Association\/American Stroke Association","volume":"44","author":"Sacco","year":"2013","journal-title":"Stroke"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1016\/j.jacc.2017.12.028","article-title":"Multivessel Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction With Cardiogenic Shock","volume":"71","author":"Lee","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2344","DOI":"10.1161\/CIRCULATIONAHA.106.685313","article-title":"Clinical end points in coronary stent trials: A case for standardized definitions","volume":"115","author":"Cutlip","year":"2007","journal-title":"Circulation"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"166","DOI":"10.1016\/j.atherosclerosis.2018.11.030","article-title":"Impact of renin-angiotensin system inhibitors on long-term clinical outcomes in patients with acute myocardial infarction treated with successful percutaneous coronary intervention with drug-eluting stents: Comparison between STEMI and NSTEMI","volume":"280","author":"Kim","year":"2019","journal-title":"Atherosclerosis"},{"key":"ref_18","first-page":"227","article-title":"Multicollinearity in Regression Analyses Conducted in Epidemiologic Studies","volume":"6","author":"Vatcheva","year":"2016","journal-title":"Epidemiology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"558","DOI":"10.4097\/kja.19087","article-title":"Multicollinearity and misleading statistical results","volume":"72","author":"Kim","year":"2019","journal-title":"Korean J. Anesthesiol."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Kalantari, S., Khalili, D., Asgari, S., Fahimfar, N., Hadaegh, F., Tohidi, M., and Azizi, F. (2017). Predictors of early adulthood hypertension during adolescence: A population-based cohort study. BMC Public Health, 17.","DOI":"10.1186\/s12889-017-4922-3"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"8513257","DOI":"10.1155\/2020\/8513257","article-title":"Optimal Timing of Invasive Coronary Angiography following NSTEMI","volume":"2020","author":"Mahendiran","year":"2020","journal-title":"J. Interv. Cardiol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1016\/j.ijcard.2014.04.089","article-title":"Age- and sex-related differences in coronary plaque high-risk features in patients with acute coronary syndrome assessed by computed tomography angiography","volume":"174","author":"Kitagawa","year":"2014","journal-title":"Int. J. Cardiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"789","DOI":"10.1093\/eurheartj\/ehi774","article-title":"Age, clinical presentation, and outcome of acute coronary syndromes in the Euroheart acute coronary syndrome survey","volume":"27","author":"Rosengren","year":"2006","journal-title":"Eur. Heart J."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1892","DOI":"10.1001\/jama.297.17.1892","article-title":"Decline in rates of death and heart failure in acute coronary syndromes, 1999\u20132006","volume":"297","author":"Fox","year":"2007","journal-title":"JAMA"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ijcard.2021.12.028","article-title":"Early angiography in elderly patients with non-ST-segment elevation acute coronary syndrome: The cardio CHUS-HUSJ registry","volume":"351","author":"Cordero","year":"2022","journal-title":"Int. J. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1093\/eurheartj\/ehm464","article-title":"Effect of an invasive strategy on in-hospital outcome in elderly patients with non-ST-elevation myocardial infarction","volume":"28","author":"Bauer","year":"2007","journal-title":"Eur. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"186","DOI":"10.7326\/0003-4819-141-3-200408030-00007","article-title":"The effect of routine, early invasive management on outcome for elderly patients with non-ST-segment elevation acute coronary syndromes","volume":"141","author":"Bach","year":"2004","journal-title":"Ann. Intern. Med."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Kim, Y.H., Her, A.Y., Jeong, M.H., Kim, B.K., Hong, S.J., Park, S.H., Kim, B.G., Kim, S., Ahn, C.M., and Kim, J.S. (2021). Outcomes between prediabetes and type 2 diabetes mellitus in older adults with acute myocardial infarction in the era of newer-generation drug-eluting stents: A retrospective observational study. BMC Geriatr., 21.","DOI":"10.1186\/s12877-021-02601-3"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2549","DOI":"10.1161\/CIRCULATIONAHA.107.182615","article-title":"Acute coronary care in the elderly, part I: Non-ST-segment-elevation acute coronary syndromes: A scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: In collaboration with the Society of Geriatric Cardiology","volume":"115","author":"Alexander","year":"2007","journal-title":"Circulation"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.2337\/dc12-1801","article-title":"Diabetes in older adults","volume":"35","author":"Kirkman","year":"2012","journal-title":"Diabetes Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/S0140-6736(12)60240-2","article-title":"Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study","volume":"380","author":"Barnett","year":"2012","journal-title":"Lancet"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1093\/eurheartj\/ehv320","article-title":"2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)","volume":"37","author":"Roffi","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"9364","DOI":"10.1038\/s41598-021-88593-x","article-title":"Effects of stent generation on clinical outcomes after acute myocardial infarction compared between prediabetes and diabetes patients","volume":"11","author":"Kim","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1016\/S0140-6736(15)01166-6","article-title":"Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): An open-label randomised controlled trial","volume":"387","author":"Tegn","year":"2016","journal-title":"Lancet"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/BF02592271","article-title":"Age-related changes in the hemostatic system","volume":"23","author":"Abbate","year":"1993","journal-title":"Int. J. Clin. Lab. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"286","DOI":"10.1016\/j.cardiores.2004.12.027","article-title":"Endothelial aging","volume":"66","author":"Brandes","year":"2005","journal-title":"Cardiovasc. Res."},{"key":"ref_37","first-page":"457","article-title":"Update on pharmacological treatment of acute coronary syndrome without persistent ST segment elevation myocardial infarction in the elderly","volume":"14","author":"Usta","year":"2017","journal-title":"J. Geriatr. Cariol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1056\/NEJM200106213442501","article-title":"Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb\/IIIa inhibitor tirofiban","volume":"344","author":"Cannon","year":"2001","journal-title":"N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1016\/j.jacc.2021.02.041","article-title":"KAMIR-NIH Investigators. Long-Term Outcomes of Patients With Late Presentation of ST-Segment Elevation Myocardial Infarction","volume":"77","author":"Cho","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e023481","DOI":"10.1161\/JAHA.121.023481","article-title":"Role of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention in Optimizing Outcomes in Acute Myocardial Infarction","volume":"11","author":"Kim","year":"2022","journal-title":"J. Am. Heart Assoc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/16\/4780\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:10:37Z","timestamp":1760141437000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/16\/4780"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,16]]},"references-count":40,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["jcm11164780"],"URL":"https:\/\/doi.org\/10.3390\/jcm11164780","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,8,16]]}}}