Table 2 Open in new tab Randomized...

Study and population	Outcome	Results
	Early invasive (%) vs. initially conservative (%)	HR, early invasive vs. initially conservative (95% CI)	P-value
Savonitto et al. Italian Elderly ACS (2012) (IV) n = 313 NSTEACS ≥75 years old	Primary endpoint: death, re-infarction, disabling stroke, repeat hospital stay for cardiovascular causes, and severe bleeding at 1 year	27.9 vs. 34.6	0.80 (0.53–1.19)	0.26
Primary endpoint in patients with elevated troponin levels	22.1 vs. 40.0	0.43 (0.23–0.80)	0.0375
Primary endpoint in patients with normal troponin levels	37.7 vs. 26.7	1.67 (0.75–3.70)	—^a
Death at 1 year	12.3 vs. 13.8	0.87 (0.49–1.56)	0.65
Re-infarction at 1 year	7.1 vs. 10.7	0.67 (0.33–1.36)	0.27
Repeat hospital stay for cardiovascular causes or severe bleeding at 1 year	11.7 vs. 13.8	0.81 (0.45–1.46)	0.49
Recurrent ischaemia during hospitalization	0.6 vs. 9.4	—	0.0004
	Early invasive (%) vs. conservative (%)	HR, early invasive vs. conservative (95% CI)	P-value
Tegn et al. After Eighty (2016) (V) n = 457 NSTEACS ≥80 years old	Primary endpoint: death, re-infarction, need for urgent revascularization, and stroke at mean follow-up of 18 months	41 vs. 61	0.53 (0.41–0.69)	0.0001
Death over follow-up	25 vs. 27	0.89 (0.62–1.28)	0.534
Re-infarction over follow-up	17 vs. 30	0.52 (0.35–0.76)	0.001
Need for urgent revascularization over follow-up	2 vs. 11	0.19 (0.07–0.52)	0.001
Stroke over follow-up	3 vs. 6	0.60 (0.25–1.46)	0.265
Major bleeding	1.7 vs. 1.8	—	—
	Routine invasive (%) vs. selective invasive (%)	IRR, routine invasive vs. selective invasive (95% CI)	P-value
Sanchis et al. MOSCA (2016) (VI) n = 106 NSTEMI ≥70 years old with two comorbidities	Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years	—	0.95 (0.47–1.92)	0.877
All-cause mortality	42 vs. 48	0.69 (0.39–1.23)	0.205
Re-infarction	—	1.24 (0.52–2.96)	—
Bleeding episodes	—	0.45 (0.10–2.13)	0.289
		HR, routine invasive vs. selective invasive (95% CI)	P-value
Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years (first-event analysis)	—	0.77 (0.48–1.24)	0.285
Mortality at 3 months	—	0.35 (0.12–0.99)	0.048
Mortality at the end of follow-up	—	0.69 (0.39–1.23)	0.205
Mortality or ischaemic events at 3 months	—	0.43 (0.19–0.98)	0.046
Mortality or ischaemic events at the end of follow-up	—	0.70 (0.42–1.19)	0.194
	Invasive (%) vs. conservative (%)	HR, invasive vs. conservative (95% CI)	P-value
Hirlekar et al. (2020) (VII) n = 186 NSTEACS ≥80 years old	Primary endpoint: all-cause mortality, re-infarction, stroke, urgent revascularization, or re-hospitalization for cardiac causes at 1 year	34.3 vs. 37.7	0.90 (0.55–1.46)	0.66
All-cause mortality	11.0 vs. 15.2	0.70 (0.31–1.58)	0.40
Re-infarction	12.9 vs. 22.3	0.56 (0.27–1.18)	0.13
Stroke	3.7 vs. 2.3	1.35 (0.23–7.98)	0.74
Urgent revascularization	4.6 vs. 16.5	0.29 (0.10–0.85)	0.02
Re-hospitalization for cardiac causes	15.2 vs. 9.4	1.62 (0.67–3.90)	0.28
MACCE within 1 month	11.9 vs. 16.2	0.72 (0.33–1.56)	0.40
Minor bleeding within 1 month	4.4 vs. 2.2	1.81 (0.34–9.61)	0.49
		Routine invasive (%) vs. selective invasive (%)	HR, routine invasive vs. selective invasive (95% CI)	P-value
De Belder et al. RINCAL (2020) (VIII) n = 251 NSTEMI ≥80 years old	Primary endpoint: all-cause mortality and re-infarction at 1 year	18.5 vs. 22.2	0.79 (0.45–1.35)	0.39
All-cause mortality at 1 year	10.5 vs. 11.1	0.94 (0.44–1.99)	0.86
Non-fatal re-infarction at 1 year	9.7 vs. 14.3	0.64 (0.31–1.32)	0.23
Unplanned revascularization at 1 year	1.6 vs. 6.4	—	0.10
Major bleeding	5.6 vs. 2.4	—	0.21
Angina symptoms^b at 3 months	8.8 vs. 19.0		< 0.001
Angina symptoms^b at 1 year	15.0 vs. 16.8		0.25

Study and population

Outcome

Results

Early invasive (%) vs. initially conservative (%)

HR, early invasive vs. initially conservative (95% CI)

P-value

Savonitto et al. Italian Elderly ACS (2012) (IV)
n = 313
NSTEACS
≥75 years old

Primary endpoint: death, re-infarction, disabling stroke, repeat hospital stay for cardiovascular causes, and severe bleeding at 1 year

27.9 vs. 34.6

0.80 (0.53–1.19)

0.26

Primary endpoint in patients with elevated troponin levels

22.1 vs. 40.0

0.43 (0.23–0.80)

0.0375

Primary endpoint in patients with normal troponin levels

37.7 vs. 26.7

1.67 (0.75–3.70)

—^a

Death at 1 year

12.3 vs. 13.8

0.87 (0.49–1.56)

0.65

Re-infarction at 1 year

7.1 vs. 10.7

0.67 (0.33–1.36)

0.27

Repeat hospital stay for cardiovascular causes or severe bleeding at 1 year

11.7 vs. 13.8

0.81 (0.45–1.46)

0.49

Recurrent ischaemia during hospitalization

0.6 vs. 9.4

—

0.0004

Early invasive (%) vs. conservative (%)

HR, early invasive vs. conservative (95% CI)

P-value

Tegn et al. After Eighty (2016) (V)
n = 457
NSTEACS
≥80 years old

Primary endpoint: death, re-infarction, need for urgent revascularization, and stroke at mean follow-up of 18 months

41 vs. 61

0.53 (0.41–0.69)

0.0001

Death over follow-up

25 vs. 27

0.89 (0.62–1.28)

0.534

Re-infarction over follow-up

17 vs. 30

0.52 (0.35–0.76)

0.001

Need for urgent revascularization over follow-up

2 vs. 11

0.19 (0.07–0.52)

0.001

Stroke over follow-up

3 vs. 6

0.60 (0.25–1.46)

0.265

Major bleeding

1.7 vs. 1.8

—

Routine invasive (%) vs. selective invasive (%)

IRR, routine invasive vs. selective invasive (95% CI)

P-value

Sanchis et al. MOSCA (2016) (VI)
n = 106
NSTEMI
≥70 years old with two comorbidities

Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years

—

0.95 (0.47–1.92)

0.877

All-cause mortality

42 vs. 48

0.69 (0.39–1.23)

0.205

Re-infarction

—

1.24 (0.52–2.96)

—

Bleeding episodes

—

0.45 (0.10–2.13)

0.289

HR, routine invasive vs. selective invasive (95% CI)

P-value

Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years (first-event analysis)

—

0.77 (0.48–1.24)

0.285

Mortality at 3 months

—

0.35 (0.12–0.99)

0.048

Mortality at the end of follow-up

—

0.69 (0.39–1.23)

0.205

Mortality or ischaemic events at 3 months

—

0.43 (0.19–0.98)

0.046

Mortality or ischaemic events at the end of follow-up

—

0.70 (0.42–1.19)

0.194

Invasive (%) vs. conservative (%)

HR, invasive vs. conservative (95% CI)

P-value

Hirlekar et al. (2020) (VII)
n = 186
NSTEACS
≥80 years old

Primary endpoint: all-cause mortality, re-infarction, stroke, urgent revascularization, or re-hospitalization for cardiac causes at 1 year

34.3 vs. 37.7

0.90 (0.55–1.46)

0.66

All-cause mortality

11.0 vs. 15.2

0.70 (0.31–1.58)

0.40

Re-infarction

12.9 vs. 22.3

0.56 (0.27–1.18)

0.13

Stroke

3.7 vs. 2.3

1.35 (0.23–7.98)

0.74

Urgent revascularization

4.6 vs. 16.5

0.29 (0.10–0.85)

0.02

Re-hospitalization for cardiac causes

15.2 vs. 9.4

1.62 (0.67–3.90)

0.28

MACCE within 1 month

11.9 vs. 16.2

0.72 (0.33–1.56)

0.40

Minor bleeding within 1 month

4.4 vs. 2.2

1.81 (0.34–9.61)

0.49

Routine invasive (%) vs. selective invasive (%)

HR, routine invasive vs. selective invasive (95% CI)

P-value

De Belder et al. RINCAL (2020) (VIII)
n = 251
NSTEMI
≥80 years old

Primary endpoint: all-cause mortality and re-infarction at 1 year

18.5 vs. 22.2

0.79 (0.45–1.35)

0.39

All-cause mortality at 1 year

10.5 vs. 11.1

0.94 (0.44–1.99)

0.86

Non-fatal re-infarction at 1 year

9.7 vs. 14.3

0.64 (0.31–1.32)

0.23

Unplanned revascularization at 1 year

1.6 vs. 6.4

—

0.10

Major bleeding

5.6 vs. 2.4

—

0.21

Angina symptoms^b at 3 months

8.8 vs. 19.0

< 0.001

Angina symptoms^b at 1 year

15.0 vs. 16.8

0.25

Study and population	Outcome	Results
	Early invasive (%) vs. initially conservative (%)	HR, early invasive vs. initially conservative (95% CI)	P-value
Savonitto et al. Italian Elderly ACS (2012) (IV) n = 313 NSTEACS ≥75 years old	Primary endpoint: death, re-infarction, disabling stroke, repeat hospital stay for cardiovascular causes, and severe bleeding at 1 year	27.9 vs. 34.6	0.80 (0.53–1.19)	0.26
Primary endpoint in patients with elevated troponin levels	22.1 vs. 40.0	0.43 (0.23–0.80)	0.0375
Primary endpoint in patients with normal troponin levels	37.7 vs. 26.7	1.67 (0.75–3.70)	—^a
Death at 1 year	12.3 vs. 13.8	0.87 (0.49–1.56)	0.65
Re-infarction at 1 year	7.1 vs. 10.7	0.67 (0.33–1.36)	0.27
Repeat hospital stay for cardiovascular causes or severe bleeding at 1 year	11.7 vs. 13.8	0.81 (0.45–1.46)	0.49
Recurrent ischaemia during hospitalization	0.6 vs. 9.4	—	0.0004
	Early invasive (%) vs. conservative (%)	HR, early invasive vs. conservative (95% CI)	P-value
Tegn et al. After Eighty (2016) (V) n = 457 NSTEACS ≥80 years old	Primary endpoint: death, re-infarction, need for urgent revascularization, and stroke at mean follow-up of 18 months	41 vs. 61	0.53 (0.41–0.69)	0.0001
Death over follow-up	25 vs. 27	0.89 (0.62–1.28)	0.534
Re-infarction over follow-up	17 vs. 30	0.52 (0.35–0.76)	0.001
Need for urgent revascularization over follow-up	2 vs. 11	0.19 (0.07–0.52)	0.001
Stroke over follow-up	3 vs. 6	0.60 (0.25–1.46)	0.265
Major bleeding	1.7 vs. 1.8	—	—
	Routine invasive (%) vs. selective invasive (%)	IRR, routine invasive vs. selective invasive (95% CI)	P-value
Sanchis et al. MOSCA (2016) (VI) n = 106 NSTEMI ≥70 years old with two comorbidities	Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years	—	0.95 (0.47–1.92)	0.877
All-cause mortality	42 vs. 48	0.69 (0.39–1.23)	0.205
Re-infarction	—	1.24 (0.52–2.96)	—
Bleeding episodes	—	0.45 (0.10–2.13)	0.289
		HR, routine invasive vs. selective invasive (95% CI)	P-value
Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years (first-event analysis)	—	0.77 (0.48–1.24)	0.285
Mortality at 3 months	—	0.35 (0.12–0.99)	0.048
Mortality at the end of follow-up	—	0.69 (0.39–1.23)	0.205
Mortality or ischaemic events at 3 months	—	0.43 (0.19–0.98)	0.046
Mortality or ischaemic events at the end of follow-up	—	0.70 (0.42–1.19)	0.194
	Invasive (%) vs. conservative (%)	HR, invasive vs. conservative (95% CI)	P-value
Hirlekar et al. (2020) (VII) n = 186 NSTEACS ≥80 years old	Primary endpoint: all-cause mortality, re-infarction, stroke, urgent revascularization, or re-hospitalization for cardiac causes at 1 year	34.3 vs. 37.7	0.90 (0.55–1.46)	0.66
All-cause mortality	11.0 vs. 15.2	0.70 (0.31–1.58)	0.40
Re-infarction	12.9 vs. 22.3	0.56 (0.27–1.18)	0.13
Stroke	3.7 vs. 2.3	1.35 (0.23–7.98)	0.74
Urgent revascularization	4.6 vs. 16.5	0.29 (0.10–0.85)	0.02
Re-hospitalization for cardiac causes	15.2 vs. 9.4	1.62 (0.67–3.90)	0.28
MACCE within 1 month	11.9 vs. 16.2	0.72 (0.33–1.56)	0.40
Minor bleeding within 1 month	4.4 vs. 2.2	1.81 (0.34–9.61)	0.49
		Routine invasive (%) vs. selective invasive (%)	HR, routine invasive vs. selective invasive (95% CI)	P-value
De Belder et al. RINCAL (2020) (VIII) n = 251 NSTEMI ≥80 years old	Primary endpoint: all-cause mortality and re-infarction at 1 year	18.5 vs. 22.2	0.79 (0.45–1.35)	0.39
All-cause mortality at 1 year	10.5 vs. 11.1	0.94 (0.44–1.99)	0.86
Non-fatal re-infarction at 1 year	9.7 vs. 14.3	0.64 (0.31–1.32)	0.23
Unplanned revascularization at 1 year	1.6 vs. 6.4	—	0.10
Major bleeding	5.6 vs. 2.4	—	0.21
Angina symptoms^b at 3 months	8.8 vs. 19.0		< 0.001
Angina symptoms^b at 1 year	15.0 vs. 16.8		0.25

Study and population

Outcome

Results

Early invasive (%) vs. initially conservative (%)

HR, early invasive vs. initially conservative (95% CI)

P-value

Savonitto et al. Italian Elderly ACS (2012) (IV)
n = 313
NSTEACS
≥75 years old

Primary endpoint: death, re-infarction, disabling stroke, repeat hospital stay for cardiovascular causes, and severe bleeding at 1 year

27.9 vs. 34.6

0.80 (0.53–1.19)

0.26

Primary endpoint in patients with elevated troponin levels

22.1 vs. 40.0

0.43 (0.23–0.80)

0.0375

Primary endpoint in patients with normal troponin levels

37.7 vs. 26.7

1.67 (0.75–3.70)

—^a

Death at 1 year

12.3 vs. 13.8

0.87 (0.49–1.56)

0.65

Re-infarction at 1 year

7.1 vs. 10.7

0.67 (0.33–1.36)

0.27

Repeat hospital stay for cardiovascular causes or severe bleeding at 1 year

11.7 vs. 13.8

0.81 (0.45–1.46)

0.49

Recurrent ischaemia during hospitalization

0.6 vs. 9.4

—

0.0004

Early invasive (%) vs. conservative (%)

HR, early invasive vs. conservative (95% CI)

P-value

Tegn et al. After Eighty (2016) (V)
n = 457
NSTEACS
≥80 years old

Primary endpoint: death, re-infarction, need for urgent revascularization, and stroke at mean follow-up of 18 months

41 vs. 61

0.53 (0.41–0.69)

0.0001

Death over follow-up

25 vs. 27

0.89 (0.62–1.28)

0.534

Re-infarction over follow-up

17 vs. 30

0.52 (0.35–0.76)

0.001

Need for urgent revascularization over follow-up

2 vs. 11

0.19 (0.07–0.52)

0.001

Stroke over follow-up

3 vs. 6

0.60 (0.25–1.46)

0.265

Major bleeding

1.7 vs. 1.8

—

Routine invasive (%) vs. selective invasive (%)

IRR, routine invasive vs. selective invasive (95% CI)

P-value

Sanchis et al. MOSCA (2016) (VI)
n = 106
NSTEMI
≥70 years old with two comorbidities

Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years

—

0.95 (0.47–1.92)

0.877

All-cause mortality

42 vs. 48

0.69 (0.39–1.23)

0.205

Re-infarction

—

1.24 (0.52–2.96)

—

Bleeding episodes

—

0.45 (0.10–2.13)

0.289

HR, routine invasive vs. selective invasive (95% CI)

P-value

Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years (first-event analysis)

—

0.77 (0.48–1.24)

0.285

Mortality at 3 months

—

0.35 (0.12–0.99)

0.048

Mortality at the end of follow-up

—

0.69 (0.39–1.23)

0.205

Mortality or ischaemic events at 3 months

—

0.43 (0.19–0.98)

0.046

Mortality or ischaemic events at the end of follow-up

—

0.70 (0.42–1.19)

0.194

Invasive (%) vs. conservative (%)

HR, invasive vs. conservative (95% CI)

P-value

Hirlekar et al. (2020) (VII)
n = 186
NSTEACS
≥80 years old

Primary endpoint: all-cause mortality, re-infarction, stroke, urgent revascularization, or re-hospitalization for cardiac causes at 1 year

34.3 vs. 37.7

0.90 (0.55–1.46)

0.66

All-cause mortality

11.0 vs. 15.2

0.70 (0.31–1.58)

0.40

Re-infarction

12.9 vs. 22.3

0.56 (0.27–1.18)

0.13

Stroke

3.7 vs. 2.3

1.35 (0.23–7.98)

0.74

Urgent revascularization

4.6 vs. 16.5

0.29 (0.10–0.85)

0.02

Re-hospitalization for cardiac causes

15.2 vs. 9.4

1.62 (0.67–3.90)

0.28

MACCE within 1 month

11.9 vs. 16.2

0.72 (0.33–1.56)

0.40

Minor bleeding within 1 month

4.4 vs. 2.2

1.81 (0.34–9.61)

0.49

Routine invasive (%) vs. selective invasive (%)

HR, routine invasive vs. selective invasive (95% CI)

P-value

De Belder et al. RINCAL (2020) (VIII)
n = 251
NSTEMI
≥80 years old

Primary endpoint: all-cause mortality and re-infarction at 1 year

18.5 vs. 22.2

0.79 (0.45–1.35)

0.39

All-cause mortality at 1 year

10.5 vs. 11.1

0.94 (0.44–1.99)

0.86

Non-fatal re-infarction at 1 year

9.7 vs. 14.3

0.64 (0.31–1.32)

0.23

Unplanned revascularization at 1 year

1.6 vs. 6.4

—

0.10

Major bleeding

5.6 vs. 2.4

—

0.21

Angina symptoms^b at 3 months

8.8 vs. 19.0

< 0.001

Angina symptoms^b at 1 year

15.0 vs. 16.8

0.25

Table 2

Open in new tab

Randomized control trials comparing invasive and conservative approaches in older patients with non-ST-elevation acute coronary syndrome

Study and population	Outcome	Results
		Early invasive (%) vs. initially conservative (%)	HR, early invasive vs. initially conservative (95% CI)	P-value
Savonitto et al. Italian Elderly ACS (2012) (IV) n = 313 NSTEACS ≥75 years old	Primary endpoint: death, re-infarction, disabling stroke, repeat hospital stay for cardiovascular causes, and severe bleeding at 1 year	27.9 vs. 34.6	0.80 (0.53–1.19)	0.26
	Primary endpoint in patients with elevated troponin levels	22.1 vs. 40.0	0.43 (0.23–0.80)	0.0375
	Primary endpoint in patients with normal troponin levels	37.7 vs. 26.7	1.67 (0.75–3.70)	—^a
	Death at 1 year	12.3 vs. 13.8	0.87 (0.49–1.56)	0.65
	Re-infarction at 1 year	7.1 vs. 10.7	0.67 (0.33–1.36)	0.27
	Repeat hospital stay for cardiovascular causes or severe bleeding at 1 year	11.7 vs. 13.8	0.81 (0.45–1.46)	0.49
	Recurrent ischaemia during hospitalization	0.6 vs. 9.4	—	0.0004
		Early invasive (%) vs. conservative (%)	HR, early invasive vs. conservative (95% CI)	P-value
Tegn et al. After Eighty (2016) (V) n = 457 NSTEACS ≥80 years old	Primary endpoint: death, re-infarction, need for urgent revascularization, and stroke at mean follow-up of 18 months	41 vs. 61	0.53 (0.41–0.69)	0.0001
	Death over follow-up	25 vs. 27	0.89 (0.62–1.28)	0.534
	Re-infarction over follow-up	17 vs. 30	0.52 (0.35–0.76)	0.001
	Need for urgent revascularization over follow-up	2 vs. 11	0.19 (0.07–0.52)	0.001
	Stroke over follow-up	3 vs. 6	0.60 (0.25–1.46)	0.265
	Major bleeding	1.7 vs. 1.8	—	—
		Routine invasive (%) vs. selective invasive (%)	IRR, routine invasive vs. selective invasive (95% CI)	P-value
Sanchis et al. MOSCA (2016) (VI) n = 106 NSTEMI ≥70 years old with two comorbidities	Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years	—	0.95 (0.47–1.92)	0.877
	All-cause mortality	42 vs. 48	0.69 (0.39–1.23)	0.205
	Re-infarction	—	1.24 (0.52–2.96)	—
	Bleeding episodes	—	0.45 (0.10–2.13)	0.289
			HR, routine invasive vs. selective invasive (95% CI)	P-value
	Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years (first-event analysis)	—	0.77 (0.48–1.24)	0.285
	Mortality at 3 months	—	0.35 (0.12–0.99)	0.048
	Mortality at the end of follow-up	—	0.69 (0.39–1.23)	0.205
	Mortality or ischaemic events at 3 months	—	0.43 (0.19–0.98)	0.046
	Mortality or ischaemic events at the end of follow-up	—	0.70 (0.42–1.19)	0.194
		Invasive (%) vs. conservative (%)	HR, invasive vs. conservative (95% CI)	P-value
Hirlekar et al. (2020) (VII) n = 186 NSTEACS ≥80 years old	Primary endpoint: all-cause mortality, re-infarction, stroke, urgent revascularization, or re-hospitalization for cardiac causes at 1 year	34.3 vs. 37.7	0.90 (0.55–1.46)	0.66
	All-cause mortality	11.0 vs. 15.2	0.70 (0.31–1.58)	0.40
	Re-infarction	12.9 vs. 22.3	0.56 (0.27–1.18)	0.13
	Stroke	3.7 vs. 2.3	1.35 (0.23–7.98)	0.74
	Urgent revascularization	4.6 vs. 16.5	0.29 (0.10–0.85)	0.02
	Re-hospitalization for cardiac causes	15.2 vs. 9.4	1.62 (0.67–3.90)	0.28
	MACCE within 1 month	11.9 vs. 16.2	0.72 (0.33–1.56)	0.40
	Minor bleeding within 1 month	4.4 vs. 2.2	1.81 (0.34–9.61)	0.49
		Routine invasive (%) vs. selective invasive (%)	HR, routine invasive vs. selective invasive (95% CI)	P-value
De Belder et al. RINCAL (2020) (VIII) n = 251 NSTEMI ≥80 years old	Primary endpoint: all-cause mortality and re-infarction at 1 year	18.5 vs. 22.2	0.79 (0.45–1.35)	0.39
	All-cause mortality at 1 year	10.5 vs. 11.1	0.94 (0.44–1.99)	0.86
	Non-fatal re-infarction at 1 year	9.7 vs. 14.3	0.64 (0.31–1.32)	0.23
	Unplanned revascularization at 1 year	1.6 vs. 6.4	—	0.10
	Major bleeding	5.6 vs. 2.4	—	0.21
	Angina symptoms^b at 3 months	8.8 vs. 19.0		< 0.001
	Angina symptoms^b at 1 year	15.0 vs. 16.8		0.25

Study and population	Outcome	Results
		Early invasive (%) vs. initially conservative (%)	HR, early invasive vs. initially conservative (95% CI)	P-value
Savonitto et al. Italian Elderly ACS (2012) (IV) n = 313 NSTEACS ≥75 years old	Primary endpoint: death, re-infarction, disabling stroke, repeat hospital stay for cardiovascular causes, and severe bleeding at 1 year	27.9 vs. 34.6	0.80 (0.53–1.19)	0.26
	Primary endpoint in patients with elevated troponin levels	22.1 vs. 40.0	0.43 (0.23–0.80)	0.0375
	Primary endpoint in patients with normal troponin levels	37.7 vs. 26.7	1.67 (0.75–3.70)	—^a
	Death at 1 year	12.3 vs. 13.8	0.87 (0.49–1.56)	0.65
	Re-infarction at 1 year	7.1 vs. 10.7	0.67 (0.33–1.36)	0.27
	Repeat hospital stay for cardiovascular causes or severe bleeding at 1 year	11.7 vs. 13.8	0.81 (0.45–1.46)	0.49
	Recurrent ischaemia during hospitalization	0.6 vs. 9.4	—	0.0004
		Early invasive (%) vs. conservative (%)	HR, early invasive vs. conservative (95% CI)	P-value
Tegn et al. After Eighty (2016) (V) n = 457 NSTEACS ≥80 years old	Primary endpoint: death, re-infarction, need for urgent revascularization, and stroke at mean follow-up of 18 months	41 vs. 61	0.53 (0.41–0.69)	0.0001
	Death over follow-up	25 vs. 27	0.89 (0.62–1.28)	0.534
	Re-infarction over follow-up	17 vs. 30	0.52 (0.35–0.76)	0.001
	Need for urgent revascularization over follow-up	2 vs. 11	0.19 (0.07–0.52)	0.001
	Stroke over follow-up	3 vs. 6	0.60 (0.25–1.46)	0.265
	Major bleeding	1.7 vs. 1.8	—	—
		Routine invasive (%) vs. selective invasive (%)	IRR, routine invasive vs. selective invasive (95% CI)	P-value
Sanchis et al. MOSCA (2016) (VI) n = 106 NSTEMI ≥70 years old with two comorbidities	Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years	—	0.95 (0.47–1.92)	0.877
	All-cause mortality	42 vs. 48	0.69 (0.39–1.23)	0.205
	Re-infarction	—	1.24 (0.52–2.96)	—
	Bleeding episodes	—	0.45 (0.10–2.13)	0.289
			HR, routine invasive vs. selective invasive (95% CI)	P-value
	Primary endpoint: death, re-infarction, or readmission for cardiac cause at 2.5 years (first-event analysis)	—	0.77 (0.48–1.24)	0.285
	Mortality at 3 months	—	0.35 (0.12–0.99)	0.048
	Mortality at the end of follow-up	—	0.69 (0.39–1.23)	0.205
	Mortality or ischaemic events at 3 months	—	0.43 (0.19–0.98)	0.046
	Mortality or ischaemic events at the end of follow-up	—	0.70 (0.42–1.19)	0.194
		Invasive (%) vs. conservative (%)	HR, invasive vs. conservative (95% CI)	P-value
Hirlekar et al. (2020) (VII) n = 186 NSTEACS ≥80 years old	Primary endpoint: all-cause mortality, re-infarction, stroke, urgent revascularization, or re-hospitalization for cardiac causes at 1 year	34.3 vs. 37.7	0.90 (0.55–1.46)	0.66
	All-cause mortality	11.0 vs. 15.2	0.70 (0.31–1.58)	0.40
	Re-infarction	12.9 vs. 22.3	0.56 (0.27–1.18)	0.13
	Stroke	3.7 vs. 2.3	1.35 (0.23–7.98)	0.74
	Urgent revascularization	4.6 vs. 16.5	0.29 (0.10–0.85)	0.02
	Re-hospitalization for cardiac causes	15.2 vs. 9.4	1.62 (0.67–3.90)	0.28
	MACCE within 1 month	11.9 vs. 16.2	0.72 (0.33–1.56)	0.40
	Minor bleeding within 1 month	4.4 vs. 2.2	1.81 (0.34–9.61)	0.49
		Routine invasive (%) vs. selective invasive (%)	HR, routine invasive vs. selective invasive (95% CI)	P-value
De Belder et al. RINCAL (2020) (VIII) n = 251 NSTEMI ≥80 years old	Primary endpoint: all-cause mortality and re-infarction at 1 year	18.5 vs. 22.2	0.79 (0.45–1.35)	0.39
	All-cause mortality at 1 year	10.5 vs. 11.1	0.94 (0.44–1.99)	0.86
	Non-fatal re-infarction at 1 year	9.7 vs. 14.3	0.64 (0.31–1.32)	0.23
	Unplanned revascularization at 1 year	1.6 vs. 6.4	—	0.10
	Major bleeding	5.6 vs. 2.4	—	0.21
	Angina symptoms^b at 3 months	8.8 vs. 19.0		< 0.001
	Angina symptoms^b at 1 year	15.0 vs. 16.8		0.25

ACS, acute coronary syndrome; CI, confidence interval; HR, hazard ratio; IRR, incidence rate ratio; MACCE, major adverse cardiac and cerebrovascular events; NSTEACS, non-ST-elevation acute coronary syndrome; NSTEMI, non-ST-elevation myocardial infarction.

A dash (—) indicates data are not available.

The rates of Canadian Cardiovascular Society (CCS) angina ‘Class 1’.

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