Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction. A Secondary Analysis of a Randomized Clinical Trial

Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM

Bibliographic Details
Authors: Sanchís, Juan, Díez-Villanueva, Pablo, Alfonso Manterola, Fernando
Format: article
Publication Date:2024
Country:España
Institution:Universidad Autónoma de Madrid
Repository:Biblos-e Archivo. Repositorio Institucional de la UAM
Language:English
OAI Identifier:oai:dnet:biblosearchi::94caa9c2cd0324608495a155fef0d5ff
Online Access:https://hdl.handle.net/10486/760421
https://dx.doi.org/10.1001/jamanetworkopen.2024.0809
Access Level:Open access
Keyword:Coronary Angiography
Data Analysis
Multicenter Studies as Topic
Frailty
Non-ST Elevated Myocardial Infarction
Randomized Controlled Trials as Topic
ST Elevation Myocardial Infarction
Medicina
id ES_ee64dd4e47a064d1c7683477d3e0f039
oai_identifier_str oai:dnet:biblosearchi::94caa9c2cd0324608495a155fef0d5ff
network_acronym_str ES
network_name_str España
repository_id_str
dc.title.none.fl_str_mv Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction. A Secondary Analysis of a Randomized Clinical Trial
title Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction. A Secondary Analysis of a Randomized Clinical Trial
spellingShingle Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction. A Secondary Analysis of a Randomized Clinical Trial
Sanchís, Juan
Coronary Angiography
Data Analysis
Multicenter Studies as Topic
Frailty
Non-ST Elevated Myocardial Infarction
Randomized Controlled Trials as Topic
ST Elevation Myocardial Infarction
Medicina
title_short Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction. A Secondary Analysis of a Randomized Clinical Trial
title_full Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction. A Secondary Analysis of a Randomized Clinical Trial
title_fullStr Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction. A Secondary Analysis of a Randomized Clinical Trial
title_full_unstemmed Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction. A Secondary Analysis of a Randomized Clinical Trial
title_sort Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction. A Secondary Analysis of a Randomized Clinical Trial
dc.creator.none.fl_str_mv Sanchís, Juan
Díez-Villanueva, Pablo
Alfonso Manterola, Fernando
author Sanchís, Juan
author_facet Sanchís, Juan
Díez-Villanueva, Pablo
Alfonso Manterola, Fernando
author_role author
author2 Díez-Villanueva, Pablo
Alfonso Manterola, Fernando
author2_role author
author
dc.contributor.none.fl_str_mv Facultad de Medicina
Departamento de Medicina
Gobierno de España
Instituto de Salud Carlos III
dc.subject.none.fl_str_mv Coronary Angiography
Data Analysis
Multicenter Studies as Topic
Frailty
Non-ST Elevated Myocardial Infarction
Randomized Controlled Trials as Topic
ST Elevation Myocardial Infarction
Medicina
topic Coronary Angiography
Data Analysis
Multicenter Studies as Topic
Frailty
Non-ST Elevated Myocardial Infarction
Randomized Controlled Trials as Topic
ST Elevation Myocardial Infarction
Medicina
description Artículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAM
publishDate 2024
dc.date.none.fl_str_mv 2024
2024-03-06
dc.type.none.fl_str_mv research article
http://purl.org/coar/resource_type/c_2df8fbb1
EVoR
http://purl.org/coar/version/c_dc82b40f9837b551
dc.type.openaire.fl_str_mv info:eu-repo/semantics/article
format article
dc.identifier.none.fl_str_mv https://hdl.handle.net/10486/760421
https://dx.doi.org/10.1001/jamanetworkopen.2024.0809
38446482
url https://hdl.handle.net/10486/760421
https://dx.doi.org/10.1001/jamanetworkopen.2024.0809
identifier_str_mv 38446482
dc.language.none.fl_str_mv Inglés
eng
language_invalid_str_mv Inglés
language eng
dc.rights.none.fl_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
dc.rights.openaire.fl_str_mv info:eu-repo/semantics/openAccess
rights_invalid_str_mv open access
http://purl.org/coar/access_right/c_abf2
Attribution 4.0 International
http://creativecommons.org/licenses/by/4.0/
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv American Medical Association
publisher.none.fl_str_mv American Medical Association
dc.source.none.fl_str_mv reponame:Biblos-e Archivo. Repositorio Institucional de la UAM
instname:Universidad Autónoma de Madrid
instname_str Universidad Autónoma de Madrid
reponame_str Biblos-e Archivo. Repositorio Institucional de la UAM
collection Biblos-e Archivo. Repositorio Institucional de la UAM
repository.name.fl_str_mv
repository.mail.fl_str_mv
_version_ 1869423641585778688
spelling Invasive Treatment Strategy in Adults With Frailty and Non–ST-Segment Elevation Myocardial Infarction. A Secondary Analysis of a Randomized Clinical TrialSanchís, JuanDíez-Villanueva, PabloAlfonso Manterola, FernandoCoronary AngiographyData AnalysisMulticenter Studies as TopicFrailtyNon-ST Elevated Myocardial InfarctionRandomized Controlled Trials as TopicST Elevation Myocardial InfarctionMedicinaArtículo escrito por un elevado número de autores, solo se referencian el que aparece en primer lugar, el nombre del grupo de colaboración, si le hubiere, y los autores pertenecientes a la UAMClinicalTrials.gov Identifier: NCT03208153IMPORTANCE The MOSCA-FRAIL randomized clinical trial compared invasive and conservative treatment strategies in patients with frailty with non–ST-segment elevationmyocardial infarction (NSTEMI). It showed no differences in the number of days alive and out of the hospital at 1 year. OBJECTIVE To assess the outcomes of the MOSCA-FRAIL trial during extended follow-up. DESIGN, SETTING, AND PARTICIPANTS The MOSCA-FRAIL randomized clinical trial was conducted at 13 hospitals in Spain between July 7, 2017, and January 9, 2021, and included 167 adults (aged 70 years) with frailty (Clinical Frailty Scale score 4) and NSTEMI. In this preplanned secondary analysis, follow-up was extended to January 31, 2023. Data analysis was performed from April 5 to 29, 2023, using the intention-to-treat principle. INTERVENTIONS Patients were randomized to a routine invasive (coronary angiography and revascularization if feasible [n = 84]) or a conservative (medical treatment with coronary angiography only if recurrent ischemia [n = 83]) strategy. MAIN OUTCOMES AND MEASURES The primary end point was the difference in restricted mean survival time (RMST). Secondary end points included readmissions for any cause, considering recurrent readmissions. RESULTS Among the 167 patients included in the analysis, the mean (SD) age was 86 (5) years; 79 (47.3%) were men and 88 (52.7%) were women. A total of 93 deaths and 367 readmissions accrued. The RMST for all-cause death over the entire follow-up was 3.13 (95%CI, 2.72-3.60) years in the invasive and 3.06 (95%CI, 2.84-3.32) years in the conservative treatment groups. The RMST analysis showed inconclusive differences in survival time (invasive minus conservative difference, 28 [95% CI, −188 to 230] days). Patients under invasive treatment tended to have shorter survival in the first year (−28 [95%CI, −63 to 7] days), which improved after the first year (192 [95%CI, 90-230] days). Kaplan-Meier mortality curves intersected, displaying higher mortality to 1 year in the invasive group that shifted to a late benefit (landmark analysis hazard ratio, 0.58 [95%CI, 0.33-0.99]; P = .045). Early harm was more evident in the subgroup with a Clinical Frailty Scale score greater than 4. No differences were found for the secondary end points. CONCLUSIONS AND RELEVANCE In this extended follow-up of a randomized clinical trial of patients with frailty and NSTEMI, an invasive treatment strategy did not improve outcomes at a median follow-up of 1113 (IQR, 443-1441) days. However, a differential distribution of deaths was observed, with early harm followed by later benefit. The phenomenon of depletion of susceptible patients may be responsible for this behaviorThis study was supported by grants FIS 17/01736 and FIS 17/00899 from Spain’s Ministry of Science and Innovation through the Carlos III Health Institute: Fondo Europeo de Desarrollo Regional and by grant 16/11/00420 from Centro de Investigación Biomédica en Red Enfermedades CardiovacularesAmerican Medical AssociationFacultad de MedicinaDepartamento de MedicinaGobierno de EspañaInstituto de Salud Carlos III20242024-03-06research articlehttp://purl.org/coar/resource_type/c_2df8fbb1EVoRhttp://purl.org/coar/version/c_dc82b40f9837b551info:eu-repo/semantics/articleapplication/pdfhttps://hdl.handle.net/10486/760421https://dx.doi.org/10.1001/jamanetworkopen.2024.080938446482reponame:Biblos-e Archivo. Repositorio Institucional de la UAMinstname:Universidad Autónoma de MadridInglésengopen accesshttp://purl.org/coar/access_right/c_abf2Attribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/info:eu-repo/semantics/openAccessoai:dnet:biblosearchi::94caa9c2cd0324608495a155fef0d5ff2026-06-23T12:46:27Z
score 15.811543

Similar Items