An invasive treatment strategy involving coronary angiography and revascularization plus medical therapy did not significantly lower the composite risk of cardiovascular death or nonfatal myocardial infarction (MI) compared with a conservative strategy of medical therapy alone in older adults with NSTEMI, according to findings from the SENIOR-RITA trial presented at ESC Congress 2024 in London and simultaneously published in The New England Journal of Medicine.

The trial randomly assigned 1,518 patients from 48 sites in the UK to either the invasive (n=753) or conservative strategy (n=765). The median age of patients was 82 years, 45% were women, 32% were frail and all had a high burden of coexisting conditions.

Over the median follow-up period of approximately four years, a primary outcome event involving a nonfatal MI or cardiovascular death occurred in 25.6% of patients assigned to the invasive strategy compared with 26.3% assigned to the conservative strategy. Broken down by event, cardiovascular death occurred in 15.8% of invasive strategy patients and 14.2% of conservative strategy patients, while nonfatal MI occurred in 11.7% and 15% of patients, respectively.

"An invasive strategy did not reduce the primary endpoint … but we did see some benefits," said Vijay Kunadian, MD. "Importantly, the invasive strategy appeared to be safe overall in our older patients. These results are consistent with our recent patient-level meta-analysis, which we are currently updating with data from SENIOR-RITA to further strengthen the evidence base in this understudied population."

Two additional late-breaking trials presented at the ESC Congress 2024 also explored screening and treatment options for older adults. In the STROKESTOP II trial, researchers found that mass screening for atrial fibrillation (AFib) using ECG together with a blood test for the heart failure biomarker did not prevent ischemic stroke or systemic embolism in older adults (>75 years) over a five-year follow-up period. However, they noted that the biomarker may improve the prediction of which individuals have a low risk for ischemic stroke and systemic embolism beyond single-lead ECG.

Researchers involved with the large EARTH-STEMI meta-analysis found the benefits of complete revascularization in older patients with MI and STEMI were confirmed. They noted that complete revascularization reduced cardiovascular events compared with culprit-only revascularization at four years and that the safety profile was similar across both groups.