2024Acute coronary syndromesIntervention1518 patients

SENIOR-RITA

Therapy group: Invasive strategy · Therapy: Invasive vs conservative strategy in older NSTEMI

In patients aged 75 or older with NSTEMI, an invasive strategy did not significantly reduce cardiovascular death or myocardial infarction versus conservative care, though it lowered infarction.

Published in N Engl J Med (2024)

Question: Is a strategy of coronary angiography and revascularization plus medical therapy more beneficial than medical therapy alone in older adults with non-ST-segment elevation myocardial infarction (NSTEMI)?
Design: Prospective, multicenter, randomized 1:1 trial conducted at 48 sites in the United Kingdom, enrolling 1518 patients with a median follow-up of 4.1 years.
Population: Patients aged 75 years or older with NSTEMI; frail patients and those with a high burden of coexisting conditions were eligible. Mean age was 82 years, 45% were women, and 32% were frail.
Intervention: Invasive strategy: coronary angiography and revascularization plus the best available medical therapy (753 patients).
Control: Conservative strategy: the best available medical therapy alone (765 patients).
Primary outcome: Composite of cardiovascular death or nonfatal myocardial infarction, assessed as time to first event.
Results: A primary-outcome event occurred in 193 patients (25.6%) in the invasive group and 201 (26.3%) in the conservative group (HR 0.94; 95% CI 0.77 to 1.14; P = 0.53). Nonfatal myocardial infarction was less frequent with the invasive strategy (11.7% vs 15.0%; HR 0.75; 95% CI 0.57 to 0.99).
Safety: Procedural complications occurred in less than 1% of patients.
Conclusion: In older adults with NSTEMI, an invasive strategy did not significantly reduce the composite of cardiovascular death or nonfatal myocardial infarction compared with a conservative strategy.
Why it matters: It provides randomized evidence specific to an elderly population, including frail patients, and helps individualize the choice between an invasive and a conservative approach.

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 14, 2026

Sources

Original publication on PubMed (PMID 39225274) ↗Invasive Treatment Strategy for Older Patients with Myocardial Infarction.
Journal article (DOI) ↗

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