Intervention for Older Patients with Non–STEMI

Older Patients With Non–ST-Segment Elevation Myocardial Infarction Randomized Interventional Treatment

The SENIOR-RITA trial, the largest randomized controlled study to date focusing on older patients with Non–ST-Segment Elevation Myocardial Infarction (NSTEMI), evaluated the outcomes of invasive versus conservative strategies in this population. It specifically included elderly individuals aged 75 and older, many of whom were frail or had multiple comorbidities.

Key findings include:

  1. Primary Endpoint: There was no significant difference in the composite outcome of cardiovascular death or non-fatal myocardial infarction (MI) between the invasive strategy group (25.6%) and the conservative strategy group (26.3%). This result suggests that routine invasive treatment may not provide superior cardiovascular protection over conservative management.
  2. Secondary Outcomes: The invasive group experienced fewer non-fatal MIs (11.7% vs. 15.0%) and fewer subsequent revascularizations compared to the conservative group. However, bleeding events were slightly higher in the invasive group, underscoring the importance of weighing risks and benefits.
  3. Safety and Applicability: Coronary revascularization using radial artery access was deemed relatively safe for older adults, challenging concerns about procedural risks in this demographic.

The trial emphasized the necessity of individualized treatment approaches, considering factors like frailty and cognitive status, rather than defaulting to invasive methods. Its findings contribute valuable insights to the ongoing debate about optimal care strategies for older NSTEMI patients, but also highlight gaps, such as the need for data on patients with higher clinical complexity​

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