Early aggressive vs. initially conservative treatment in elderly patients with non-ST-elevation acute coronary syndrome: The Italian Elderly ACS study

Stefano Savonitto, Stefano De Servi, Anna Sonia Petronio, Leonardo Bolognese, Claudio Cavallini, Cesare Greco, Ciro Indolfi, Luigi Oltrona Visconti, Federico Piscione, Giuseppe Ambrosio, Marcello Galvani, Antonio Marzocchi, Ignazio Santilli, Giuseppe Steffenino, Attilio Maseri

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BACKGROUND: Elderly patients represent one-third of all admissions for non-ST-elevation acute coronary syndrome (NSTEACS) in the coronary care units. Despite their high-risk characteristics and worse outcomes, compared with younger patients, the elderly receive less aggressive treatments, also due to less clear evidence regarding the most effective treatment strategy. PURPOSE: The Italian Elderly ACS study includes patients older than 74 years of age with NSTEACS in a multicenter randomized clinical trial, comparing an early aggressive and an initially conservative approach. Patients not enrolled due to specific exclusion criteria or any other reason will be enrolled in a Registry. CENTERS: Centers with on-site interventional cathlab and centers without on-site cathlab refering patients to a cathlab within a consolidated percutaneous coronary intervention network. PATIENTS: Patients admitted within 48 h of the most recent ischemic symptoms are eligible if they show transient ischemic ECG changes and/or CKMB/Tn elevation. Patients with secondary ischemia, ongoing ischemia, or heart failure, despite optimal therapy or recent coronary intervention, serum creatinine more than 2.5 mg/dl, high bleeding risk, and severe concomitant disease, are excluded from the study. DESIGN: Central randomization to a systematic early aggressive approach (coronary angiography within 48 h of admission and, when indicated, coronary revascularization) or an initially conservative approach (optimal medical therapy with coronary angiography in selected cases with refractory ischemia). Follow-up will include patient visits and ECG at 30 days, 6 months, and 1 year, post randomization. PRIMARY END POINT: The composite of all-cause mortality, myocardial (re)infarction, disabling stroke, and rehospitalization for cardiovascular diseases or severe bleeding within 6 months. SAMPLE SIZE: Expected primary end point rates of 30% in the conservative arm vs. 20% in the invasive arm. According to these estimates, with two-tailed α of 0.05, power will be 80, 85, or 90% with 252, 289, and 338 patients per group, respectively. The goal is to enroll 700 patients from 50 centers.

Original languageEnglish
Pages (from-to)217-226
Number of pages10
JournalJournal of Cardiovascular Medicine
Volume9
Issue number3
DOIs
Publication statusPublished - Mar 2008

Fingerprint

Acute Coronary Syndrome
Ischemia
Random Allocation
Coronary Angiography
Electrocardiography
Conservative Treatment
Hemorrhage
Coronary Care Units
Percutaneous Coronary Intervention
Therapeutics
Registries
Creatinine
Cardiovascular Diseases
Randomized Controlled Trials
Heart Failure
Stroke
Myocardial Infarction
Mortality

Keywords

  • Acute coronary syndrome
  • Elderly
  • Randomized clinical trial
  • Registry

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Early aggressive vs. initially conservative treatment in elderly patients with non-ST-elevation acute coronary syndrome : The Italian Elderly ACS study. / Savonitto, Stefano; De Servi, Stefano; Petronio, Anna Sonia; Bolognese, Leonardo; Cavallini, Claudio; Greco, Cesare; Indolfi, Ciro; Visconti, Luigi Oltrona; Piscione, Federico; Ambrosio, Giuseppe; Galvani, Marcello; Marzocchi, Antonio; Santilli, Ignazio; Steffenino, Giuseppe; Maseri, Attilio.

In: Journal of Cardiovascular Medicine, Vol. 9, No. 3, 03.2008, p. 217-226.

Research output: Contribution to journalArticle

Savonitto, S, De Servi, S, Petronio, AS, Bolognese, L, Cavallini, C, Greco, C, Indolfi, C, Visconti, LO, Piscione, F, Ambrosio, G, Galvani, M, Marzocchi, A, Santilli, I, Steffenino, G & Maseri, A 2008, 'Early aggressive vs. initially conservative treatment in elderly patients with non-ST-elevation acute coronary syndrome: The Italian Elderly ACS study', Journal of Cardiovascular Medicine, vol. 9, no. 3, pp. 217-226. https://doi.org/10.2459/JCM.0b013e3282f7c8df
Savonitto, Stefano ; De Servi, Stefano ; Petronio, Anna Sonia ; Bolognese, Leonardo ; Cavallini, Claudio ; Greco, Cesare ; Indolfi, Ciro ; Visconti, Luigi Oltrona ; Piscione, Federico ; Ambrosio, Giuseppe ; Galvani, Marcello ; Marzocchi, Antonio ; Santilli, Ignazio ; Steffenino, Giuseppe ; Maseri, Attilio. / Early aggressive vs. initially conservative treatment in elderly patients with non-ST-elevation acute coronary syndrome : The Italian Elderly ACS study. In: Journal of Cardiovascular Medicine. 2008 ; Vol. 9, No. 3. pp. 217-226.
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AU - De Servi, Stefano

AU - Petronio, Anna Sonia

AU - Bolognese, Leonardo

AU - Cavallini, Claudio

AU - Greco, Cesare

AU - Indolfi, Ciro

AU - Visconti, Luigi Oltrona

AU - Piscione, Federico

AU - Ambrosio, Giuseppe

AU - Galvani, Marcello

AU - Marzocchi, Antonio

AU - Santilli, Ignazio

AU - Steffenino, Giuseppe

AU - Maseri, Attilio

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N2 - BACKGROUND: Elderly patients represent one-third of all admissions for non-ST-elevation acute coronary syndrome (NSTEACS) in the coronary care units. Despite their high-risk characteristics and worse outcomes, compared with younger patients, the elderly receive less aggressive treatments, also due to less clear evidence regarding the most effective treatment strategy. PURPOSE: The Italian Elderly ACS study includes patients older than 74 years of age with NSTEACS in a multicenter randomized clinical trial, comparing an early aggressive and an initially conservative approach. Patients not enrolled due to specific exclusion criteria or any other reason will be enrolled in a Registry. CENTERS: Centers with on-site interventional cathlab and centers without on-site cathlab refering patients to a cathlab within a consolidated percutaneous coronary intervention network. PATIENTS: Patients admitted within 48 h of the most recent ischemic symptoms are eligible if they show transient ischemic ECG changes and/or CKMB/Tn elevation. Patients with secondary ischemia, ongoing ischemia, or heart failure, despite optimal therapy or recent coronary intervention, serum creatinine more than 2.5 mg/dl, high bleeding risk, and severe concomitant disease, are excluded from the study. DESIGN: Central randomization to a systematic early aggressive approach (coronary angiography within 48 h of admission and, when indicated, coronary revascularization) or an initially conservative approach (optimal medical therapy with coronary angiography in selected cases with refractory ischemia). Follow-up will include patient visits and ECG at 30 days, 6 months, and 1 year, post randomization. PRIMARY END POINT: The composite of all-cause mortality, myocardial (re)infarction, disabling stroke, and rehospitalization for cardiovascular diseases or severe bleeding within 6 months. SAMPLE SIZE: Expected primary end point rates of 30% in the conservative arm vs. 20% in the invasive arm. According to these estimates, with two-tailed α of 0.05, power will be 80, 85, or 90% with 252, 289, and 338 patients per group, respectively. The goal is to enroll 700 patients from 50 centers.

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