- Question
- Does a routine invasive strategy improve 1-year outcomes compared with a conservative strategy in frail older adults with non-ST-segment elevation myocardial infarction (NSTEMI)?
- Design
- Multicenter, open-label randomized clinical trial conducted at 13 Spanish hospitals with 167 patients. It was stopped early because of the COVID-19 pandemic, when 95% of the calculated sample size had been enrolled.
- Population
- Patients aged 70 years or older with frailty (Clinical Frailty Scale ≥ 4) and NSTEMI. Mean age was 86 years and mean frailty score was 5.
- Intervention
- Routine invasive strategy: in-hospital coronary angiography with revascularization if feasible (n = 84).
- Control
- Conservative strategy: medical treatment, with coronary angiography only for recurrent ischemia (n = 83).
- Primary outcome
- Number of days alive and out of the hospital from discharge to 1 year. The coprimary end point was the composite of cardiac death, reinfarction, or postdischarge revascularization.
- Results
- Days alive and out of the hospital were 312 (95% CI 289 to 335) with the conservative strategy vs 284 (95% CI 255 to 311) with the invasive strategy; the difference was 28 days (95% CI -7 to 62; P = 0.12), not statistically significant. The coprimary end point of ischemic cardiac events did not differ (subdistribution HR 0.92; 95% CI 0.54-1.57; P = 0.78).
- Safety
- There were no differences in all-cause mortality (HR 1.45; 95% CI 0.74-2.85; P = 0.28). Noncardiac causes accounted for 56% of readmissions, with no differences between groups in the number of readmissions or days in hospital after discharge.
- Conclusion
- In frail older adults with NSTEMI, a routine invasive strategy showed no benefit in days alive and out of the hospital at 1 year, so medical management with watchful observation is suggested.
- Why it matters
- It provided randomized evidence in a common population usually under-represented in large trials, and supports individualizing the decision to pursue an invasive approach according to frailty.
Card generated automatically with AI from the abstract of the original publication and the trial registry; every figure was checked against those sources. It may contain errors: verify the data at the source before using it for clinical decisions.
Generated on October 18, 2026