After Eighty Study Finds Older NSTEMI Patients Benefit From Invasive Treatment

March 16, 2015—Patients 80 years or older with acute coronary syndromes (ACS) would likely benefit from more invasive tests and therapies that may otherwise be denied them because of their age, according to the After Eighty study presented at the American College of Cardiology’s (ACC) 64th annual scientific session in San Diego, California. The After Eighty Lead Investigator is Nicolai Tegn, MD, a cardiologist at Rikshospitalet Oslo University Hospital in Oslo, Norway.

According to the ACC, the After Eighty study focused on treatment approaches for older patients with non–ST-elevation myocardial infarction (NSTEMI) or unstable angina. Patients age 80 years and older who received invasive procedures that are typically offered to younger patients to evaluate and treat narrowed arteries had a 47% reduction in the study’s primary endpoint, a combined measure of subsequent heart attacks, urgent revascularization procedures, stroke, and death, as compared to similar patients who were treated using a more conservative approach. 

In the ACC press release, Dr. Tegn stated, “Because people over 80 are underrepresented in clinical trials, they are less likely to receive treatment according to guidelines. Our study, which directly targets the over 80 population, is the first to demonstrate that a more invasive strategy results in better outcomes in these patients. I believe our study provides a sufficient basis to recommend an invasive approach.” 

As summarized by the ACC, the study included 458 patients who were treated for NSTEMI or unstable angina at 16 health centers in Norway. Patients were randomized (1:1) to receive a conservative treatment (including medications as needed but no invasive interventions) and to coronary angiography. Based on the results of the angiography, those patients were then referred by a physician for balloon angioplasty and/or stenting or for noninvasive treatments, such as medication. 

Of the 225 patients who underwent coronary angiography, 48% were subsequently treated with angioplasty or stenting, and 3% were treated with bypass surgery. At a median follow-up time of 18 months, the group who underwent coronary angiography showed a 47% reduction in the study’s primary endpoint—a composite of heart attack, urgent revascularization procedures, stroke, and death. The study did not show significant differences in the secondary endpoint (death from any cause) or in the risk of bleeding complications. 

The After Eighty investigators will continue to track patients’ outcomes over the coming years, noted the ACC press release.

Dr. Tegn concluded, “The 80 plus population is an extremely heterogeneous group, ranging from healthy individuals to people with severe illness. The fact that many 80- year-olds have nearly a decade of life ahead of them makes these results particularly noteworthy.”