SENIOR-RITA
Trial question
What is the role of an invasive strategy in elderly patients with NSTEMI?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
55.0% female
45.0% male
N = 1518
1518 patients (839 female, 679 male).
Inclusion criteria: elderly patients, ≥ 75 years of age, with NSTEMI.
Key exclusion criteria: STEMI, unstable angina, or cardiogenic shock; life expectancy < 1 year; unable to undergo invasive coronary angiography.
Interventions
N=753 invasive strategy (coronary angiography and revascularization plus best available medical therapy).
N=765 conservative strategy (best available medical therapy).
Primary outcome
CV death or nonfatal MI
25.6%
26.3%
26.3 %
19.7 %
13.2 %
6.6 %
0.0 %
Invasive
strategy
Conservative
strategy
No significant
difference ↔
No significant difference in CV death or nonfatal MI (25.6% vs. 26.3%; HR 0.94, 95% CI 0.77 to 1.14).
Secondary outcomes
No significant difference in death from any cause or nonfatal MI (42.4% vs. 42%; HR 0.97, 95% CI 0.83 to 1.13).
No significant difference in death from any cause (36.1% vs. 32.3%; HR 1.13, 95% CI 0.95 to 1.34).
No significant difference in nonCV death (20.3% vs. 18%; HR 1.14, 95% CI 0.9 to 1.43).
Conclusion
In elderly patients, ≥ 75 years of age, with NSTEMI, invasive strategy was not superior to conservative strategy with respect to CV death or nonfatal MI.
Reference
Vijay Kunadian, Helen Mossop, Carol Shields et al. Invasive Treatment Strategy for Older Patients with Myocardial Infarction. N Engl J Med. 2024 Nov 7;391(18):1673-1684.
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