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August 22, 2026European Heart Journal OpenOpen Access

Angiographic Characteristics of Older Patients with Non-ST Elevation Myocardial Infarction Undergoing Invasive Strategy

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Why the study?

To describe the angiographic characteristics of older NSTEMI patients randomized to the invasive strategy arm in the SENIOR-RITA trial.

What are the angiographic characteristics and procedural outcomes of older adults (≥75 years) with NSTEMI undergoing an invasive strategy?

Population

667 NSTEMI patients aged ≥75 years undergoing QCA analysis in the invasive arm

Design

Angiographic sub-study of a prospective multicentre randomized controlled trial

Key result

Among older adults with NSTEMI assigned to an invasive strategy, obstructive coronary artery disease was found in 76.8% of patients, and 49.5% underwent percutaneous coronary intervention.

Authors

GPGraziella PompeiFRFrancesca RubinoKJKenny Jenkins

Discussion

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Overview

Supports invasive evaluation in selected older NSTEMI patients; leaves open need for RCTs on net benefit vs conservative care.

Key Points

  • To evaluate the coronary angiographic characteristics and lesion complexity in older adults aged 75 years and older presenting with non-ST-elevation myocardial infarction.
  • Sub-study of the multicenter SENIOR-RITA randomized controlled trial across 48 UK sites, analyzing patients aged ≥75 years randomized 1:1 to an invasive strategy between November 2016 and March 2023.
  • Quantitative coronary angiography (QCA) was conducted on 667 patients (out of 680 undergoing angiography) at a central core laboratory to classify coronary anatomy and lesion complexity.
  • Obstructive coronary artery disease was identified in 76.8% of patients, 13% had prior coronary artery bypass surgery, and 29.5% of the 1,173 identified lesions were classified as ACC/AHA type B2.
  • Percutaneous coronary intervention (PCI) was performed in 49.5% of patients (n=330) with a 96.5% procedural success rate and minimal complications.
  • Lesions in patients managed without PCI showed greater anatomical complexity, featuring a higher prevalence of type C, bifurcation, and ostial lesions, as well as collateral vessels.

Study Design

Type

RCT (n=1,518)

Randomization

1:1

Multicenter

Yes

Structured PICO

What are the angiographic characteristics and procedural outcomes of older adults (≥75 years) with NSTEMI undergoing an invasive strategy?

P
Population
1,518 older adults (aged ≥75 years) with NSTEMI randomized to an invasive or conservative strategy, with 667 undergoing quantitative coronary angiography analysis.
I
Intervention
Invasive strategy (coronary angiography with potential percutaneous coronary intervention or coronary artery bypass grafting)
O
Outcome
Angiographic characteristics, lesion complexity, and procedural outcomes (PCI success)surrogate

In older adults (≥75 years) with NSTEMI undergoing an invasive strategy, obstructive CAD is present in approximately 77% of patients, and PCI can be performed with a high success rate (96.5%) despite complex lesion characteristics.

Cite This Study

Pompei et al. (2026) conducted an RCT in Non-ST-elevation myocardial infarction (NSTEMI) (n=1,518). Invasive strategy vs. Conservative strategy was evaluated on Composite outcome of cardiovascular death or non-fatal myocardial infarction. Among older adults with NSTEMI assigned to an invasive strategy, obstructive coronary artery disease was found in 76.8% of patients, and 49.5% underwent percutaneous coronary intervention.

synapsesocial.com/papers/6a89600eca7ade938187f25ehttps://doi.org/10.1093/ehjopen/oeag131
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