Shared decision-making key for invasive vs. conservative MI strategy in elderly: SENIOR-RITA
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Key takeaways:
- Non-STEMI is common in adults older than 70 years but optimal care is underutilized, researchers said.
- SENIOR-RITA is the largest trial comparing an invasive vs. conservative strategy in older adults with MI.
For older adults with non-STEMI, routine coronary intervention was safe but did not lower risk for death from CV causes or nonfatal MI compared with medical therapy alone, according to new data from the SENIOR-RITA trial.
“Our study, in a sense, provides a foundation for older heart attack patients and their clinicians to make informed decisions about whether they need to undergo invasive procedures or not,” Vijay Kunadian, MBBS, MD, MRCP, FRCP, FACC, FESC, personal chair and clinical professor of interventional cardiology at Newcastle University and honorary academic consultant interventional cardiologist at Freeman Hospital in Newcastle upon Tyne, U.K., said during a press conference at the European Society of Cardiology Congress.
SENIOR-RITA enrolled 1,518 adults aged 75 years and older (45% women) with type 1 non-STEMI at 48 sites in England and Scotland. Nearly three-quarters were aged older than 80 years (mean age, 82 years); the oldest patient enrolled was 103 years, according to Kunadian. Eighty percent were pre-frail or frail, 60% had cognitive impairment and the majority had a high burden of coexisting conditions.
“This is the largest trial to date in older adults with heart attack than all previous studies combined,” Kunadian said.
The SENIOR-RITA trial was important to undertake because optimal care is underutilized in older patients, according to Kunadian. Half of non-STEMIs occur in patients aged older than 70 years, Kunadian said. However, only 14% of patients aged 85 years and older receive angiography, she said.
“As our population is getting older, we are treating more and more older patients. We see more people coming to the cath lab with coronary artery disease and MI. But not all older patients are the same,” Kunadian said during the Hot Line trial presentation.
The results were simultaneously published in The New England Journal of Medicine.
During a median follow-up of 4.1 years, the primary endpoint of CV death or nonfatal MI occurred in 25.6% of patients randomly assigned to an invasive strategy of coronary angiography and revascularization on top of best-available medical therapy compared with 26.3% of those assigned to a more conservative strategy of continued medical therapy only (HR = 0.94; 95% CI, 0.77-1.14; P = .53).
Looking at CV death only, 15.8% of patients assigned the invasive strategy and 14.2% of patients assigned the conservative strategy died during follow-up (HR = 1.11; 95% CI, 0.86-1.44).
Kunadian said following the invasive strategy did reduce risk for nonfatal MI alone (11.7% vs. 15%; HR = 0.75; 95% CI, 0.57-0.99) or subsequent revascularization (3.9% vs. 13.7%; HR = 0.26; 95% CI, 0.17-0.39).
There were no differences between the groups in all-cause death, all-cause death/nonfatal MI, non-CV death, fatal or nonfatal MI, stroke, transient ischemic attack, HF hospitalization and bleeding, according to the researchers.
Fewer than 1% of patients experienced procedural complications, the researchers reported.
The researchers noted several limitations of the trial, including a lower-than-anticipated number of patients enrolled and incidence of primary outcome events.
Reference:
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Kunadian V, et al. Hot line 8. Presented at: European Society of Cardiology Congress; Aug. 30-Sept. 2, 2024; London (hybrid meeting).
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