Italian Elderly ACS.

Methods	Prospective, randomised, multicentre trial
Participants	313 participants with symptoms suggestive of acute myocardial ischaemia at rest within 48 hours before randomisation and ischaemic ECG changes (transient or persistent ST‐segment elevation or depression > 0.5 mm but < 1 mm in the case of ST‐elevation or persistent and definite T wave inversion > 1 mm in at least 2 contiguous leads) and/or elevate levels (> upper limit of normal) of creatine kinase‐myocardial band (CK‐MB) or cTn. Overall impression of level of risk in participants: high risk; all participants were elderly (≥ 75 years of age).
Interventions	Early aggressive strategy (coronary angiography and, when indicated, revascularization within 72 hours) or initially conservative strategy (angiography and revascularization only for recurrent ischaemia).
Outcomes	All‐cause death (6 months, 1 year), MI (6 months, 1 year), rehospitalisation (6 month, 1 year), major bleeding (6 months, 1 year), days spent in hospital (6 months, 1 year), stroke (6 month, 1 year).
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Computer generated list, stratified by the centre, and randomly balanced every 4, 6 or 8 participants for each centre.
Allocation concealment (selection bias)	Low risk	Centralised randomisation was immediately made available to the investigator upon registering the participant on the website http://elderly.altavianet.it.
Blinding (performance bias and detection bias) All outcomes	High risk	Open.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Assessments were collected in a web‐based case report form. This was audited/supervised by study monitors who visit study centres. An independent event adjudication committee adjudicated all serious adverse events on the basis of the review of the original source documents.
Incomplete outcome data (attrition bias) All outcomes	Low risk	Four participants were lost to follow‐up and 2 participants withdrew. Attrition was equal between groups. All recruited participants were accounted for in analysis of each group on an ITT basis.
Other bias	Low risk	There was no industry sponsorship.