Abstract 079: Health-related Quality of Life With Routine Invasive versus Ischemia-guided Strategies for the Elderly With Non-ST Elevation Myocardial Infarction (NSTEMI)- Insights From PREMIER/TRIUMPH

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Introduction: In elderly patients presenting with a NSTEMI, a routine invasive strategy reduces cardiovascular events as compared with an ischemia guided approach. However, the association of invasive management on health status outcomes is unknown.

Methods: Among patients admitted with NSTEMI from 2 multicenter US AMI registries (TRIUMPH and PREMIER), health status was assessed at baseline and at 1, 6 and 12 months after AMI using the Seattle Angina Questionnaire (SAQ), a CAD-specific health status measure (scores range 0-100, higher scores=better QoL; ~5-points is minimally clinically relevant difference). Invasive management was defined as coronary angiography within 72 hours of admission without a preceding stress test. Propensity-adjusted linear mixed effect models were used to compare health status between treatment strategies over the year after MI. Interactions of age (divided into <65, 65-74, 75-84, ≥85 years) with treatment and with time were tested.

Results: Among 3559 patients with NSTEMI, 2455 (69.0%) were treated with a routine invasive strategy. This was more common in younger patients, with 72.4% (1610/ 2223) of patients <65 years, 66.6% (476/715) of those 65-74 years, 63.1% (316/501) of those 75-84 years, and 44.2% (53/120) of those ≥ 85 years treated with a routine invasive strategy (p<0.001). In propensity-adjusted analyses (Table), invasive strategy was associated with a clinically small but statistically significant benefit on SAQ physical limitation, angina frequency, and summary scores over the year following AMI; benefits that were greatest early on. Although patients aged ≥ 85 years had slightly worse health status when treated with an invasive strategy, there was no significant interaction between age and treatment strategy for any of the health status outcomes (p≥ 0.15 for all).

Conclusions: In the setting of a NSTEMI, a routine invasive strategy is associated with small but significant health status benefits. These effects were most notable early during follow-up and did not significantly differ by age. While there was no significant interaction of treatment with age, the oldest old group appeared to derive slightly less health status benefit from a routine invasive strategy—results that will need to be confirmed in a larger study.

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