Why the study?
There was no evidence that a systematically invasive strategy yields better outcomes, particularly lower mortality, compared with a conservative approach in elderly patients with non-ST-segment elevation myocardial infarction.
Does a systematically invasive strategy reduce the composite of cardiovascular death and infarction in patients aged ≥75 years with non-ST-segment elevation myocardial infarction compared to a conservative approach?
Does a systematically invasive strategy reduce the composite of cardiovascular death and infarction in patients aged ≥75 years with non-ST-segment elevation myocardial infarction compared to a conservative approach?
In elderly patients (≥75 years) with NSTEMI, an invasive strategy does not reduce the composite of cardiovascular death and infarction compared to a conservative approach, but it does reduce subsequent infarctions and revascularizations.
Supports a conservative-first approach for older NSTEMI patients; confirms that routine.
Non-ST-segment elevation myocardial infarction is the prevalent form of infarction, especially in the elderly population. Compared with ST-segment elevation myocardial infarction, the culprit coronary artery lesion is not always traceable, and only a proportion of cases undergoing coronary angiography result in revascularization. At present, there is no evidence that a systematically invasive strategy has better outcomes, especially lower mortality, than a conservative approach. The SENIOR-RITA trial was the largest study in this regard, having randomized 1518 patients aged ≥75 years to invasive vs. conservative strategy with follow-up up to more than 4 years. Frail patients with cognitive impairment and comorbidities were not excluded. The results showed no differences between the two strategies in terms of primary endpoint (composite of cardiovascular death and infarction) or mortality, but a significant reduction in the risk of infarction and subsequent revascularization. These results confirm those of the previous meta-analysis of studies devoted to elderly patients and should be considered in terms of intervention strategy rather than revascularization efficacy. Subsequent antithrombotic therapies need to consider the frailty of these patients and their high haemorrhagic risk, with the increasing trend towards less aggressive and prolonged therapies than in the past.
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Savonitto et al. (2025) studied this question.
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