Patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris randomised to an invasive versus conservative strategy: angiographic and procedural results from the After Eighty study

Nicolai Tegn, Christian Eek, Michael Abdelnoor, Lars Aaberge, Knut Endresen, Rita Skårdal, Erlend Sturle Berg, Lars Gullestad, Bjørn Bendz, Nicolai Tegn, Christian Eek, Michael Abdelnoor, Lars Aaberge, Knut Endresen, Rita Skårdal, Erlend Sturle Berg, Lars Gullestad, Bjørn Bendz

Abstract

Objectives: We aimed to report the angiographic and procedural results of the After Eighty study (ClinicalTrials.gov, NCT01255540), and to identify independent predictors of revascularisation.

Methods: Patients of ≥80 years old with non-ST-elevation myocardial infarction and unstable angina pectoris were randomised to an invasive or conservative strategy. Angiographic and procedural results were recorded. Univariate and multivariate analyses were performed to explore variables predicting revascularisation.

Results: Among 229 patients in the invasive group, 220 underwent immediate coronary angiography (90% performed via the radial artery). Of these patients, 48% had three-vessel disease or left main stenosis, 18% two-vessel disease, 16% one-vessel disease, 17% minor coronary vessel wall changes and two patients had normal coronary arteries. Six patients (3%) underwent coronary artery bypass graft. Percutaneous coronary intervention (PCI) was performed in 107 patients (49%), with 57% treated with bare metal stents, 37% drug-eluting stents and 6% balloon angioplasty. On average, 1.7 lesions were treated and 2 stents delivered per patient. Complications included 1 major PCI-related bleeding (successfully treated), 2 minor access site-related bleedings, 3 side branch occlusions during PCI and 11 periprocedural myocardial infarctions (considered end points). Sex, bundle branch block and smoking were independent predictors of revascularisation.

Conclusions: PCI was performed in approximately half of the patients, similar to findings in younger populations. Procedural success was high, with few complications.

Trial registration number: NCT01255540.

Keywords: atherosclerosis; coronary artery disease; risk factors.

Conflict of interest statement

Competing interests: The authors declare that the paper is not under consideration elsewhere, that none of the paper’s contents have been published previously, and that all authors have read and approved the manuscript. The authors have no potential conflict of interest.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.

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