After Eighty Study

A Randomised Prospective Study of an Invasive Strategy Versus Medical Therapy in Patients Over 80 Years With Non ST-Elevation Myocardial Infarction (NSTEMI) or Unstable Angina Pectoris (UAP)

The rationale of the present clinical trial is to study whether an invasive strategy in clinical stable patients over 80 years with NSTEMI/UAP may improve rates of death, reinfarction, stroke, need of urgent revascularisation, myocardial function and quality of life. The invasive approach involves coronary angiography with immediate evaluation for three different treatment options; 1. Percutaneous coronary intervention (PCI), 2. Coronary artery bypass graft (CABG) or 3. medical treatment. Clinical practice shows that older patients are commonly treated less vigorously than younger patients and the present guidelines are based on a considerably younger population.

Inclusion Criteria:

• Age ≥ 80 years.
• Acute coronary syndrome (NSTEMI/UAP) with chest pain > 10 minutes, with or without ST-segment depression in ECG, and normal or elevated levels of troponin T or I. Elevated troponin levels are defined as values exceeding the 99 percentile of a normal population at the local laboratory at each participating site.
• Clinical stable

Exclusion Criteria:

• Age < 80 years.
• ST-segment elevation in ECG (STEMI)
• Clinical unstable with ongoing chest pain or other ischaemic symptoms/signs.
• Cardiogenic shock.
• Short life expectancy due to extra cardiac reason, ie. COPD, disseminated malignant disease, or other reason.
• Anamnestic indications for significant mental disorder, including dementia.
• Any condition which interferes with patients possibility to comply with protocol.