Evidence map›Paper›PMID 22344538›Full record

ArticleBMJ open2012

The impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes: retrospective analysis study from the ACACIA registry.

Christopher J Malkin, Roshan Prakash, Derek P Chew

Abstract read
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In one paragraph

Article in BMJ open, 2012. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 31 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
31citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

31 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Revascularisation or medical therapy in elderly patients with acute anginal syndromes: the RINCAL randomised trial.EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology · 2021
    Trial
  4. Article
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  9. A Newly Defined CHAJournal of clinical medicine · 2022
    Article
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  14. Impact of thrombus aspiration in frail STEMI patients.Aging clinical and experimental research · 2021
    Article
  15. Review
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  19. Observational
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Christopher J MalkinLeeds General Infirmary, The Yorkshire Heart Centre, Leeds, West Yorkshire, UK.
Roshan Prakash
Derek P Chew

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo evaluate the impact of increased age on outcome from a strategy of early invasive management and revascularisation in patients with acute coronary syndromes (ACS).

designRetrospective analysis of a national Acute Coronary Syndrome registry (ACACIA).

settingMultiple Australian (n=39) centres; 25% rural, 52% with onsite cardiac surgery. PATIENTS: Unselected consecutive patients admitted with confirmed ACS, total n=2559, median 99 per centre.

interventionsManagement was at the discretion of the treating physician. Analysis of outcome based on age >75 years was compared using Cox proportional hazard with a propensity model to adjust for baseline covariates.

main outcome measuresPrimary outcome was all-cause mortality. Secondary outcomes were bleeding and a composite of any vascular event or unplanned readmission.

resultsElderly patients were more likely to present with high-risk features yet were less likely to receive evidence-based medical therapies or receive diagnostic coronary angiography (75% vs 49%, p<0.0001) and early revascularisation (50% vs 30%, p<0.0001). Multivariate analysis found early revascularisation in the elderly cohort to be associated with lower 12-month mortality hazard (0.4 (0.2-0.7)) and composite outcome (0.6 (0.5-0.8)). Propensity model suggested a greater absolute benefit in elderly patients compared to others.

conclusionsFollowing presentation with ACS, elderly patients are less likely to receive evidence-based medical therapies, to be considered for an early invasive strategy and be revascularised. Increasing age is a significant barrier to physicians when considering early revascularisation. An early invasive strategy with revascularisation when performed was associated with substantial benefit and the absolute accrued benefit appears to be higher in elderly patients.

Identifiers

PMID22344538
PMCPMC3282292

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.