Effects of routine invasive management on reinfarction risk in older adults with frailty and non-ST-segment elevation myocardial infarction: a subanalysis of a randomised clinical trial
Primary result · Reinfarction, considering all-cause mortality as a competing eventResult — go to the resultSubdistribution hazard ratio 0.87 95% CI 0.54–1.40Authors' conclusion
In older adults with frailty and NSTEMI, routine invasive management did not reduce the reinfarction risk at a 3-year follow-up. The high all-cause mortality associated with frailty may limit the impact of invasive management. Due to the limited sample size and risk for type II error, these findings should be considered hypothesis-generating.
Study context
- Population
- Adults aged ≥70 years with frailty (Clinical Frailty Scale ≥4 points) and NSTEMI
- Participants
- 167 adults
- Comparison
- Invasive strategy versus the conservative strategy
- Invasiven = 84
- Conservativen = 83
- Primary endpoint
- Reinfarction, considering all-cause mortality as a competing event
- Follow-up
- 3-year median
Methodological detailsnot prespecified
- Not prespecified
Primary result
As reported in the abstract
Subdistribution hazard ratio
0.87
95% CI 0.54–1.40
P = 0.56
Invasivevs conservative
subdistribution HR 0.87 (95% CI 0.54–1.40); P = 0.56
Further findings
| Outcome | Win ratio (95% CI) | P value | |
|---|---|---|---|
| Win ratio | 1.08 (0.72–1.63) | P = 0.70 | |
| 0.512Win ratio (log scale) |
Deaths and first reinfarctions (total)
- Total deaths
- 93, 56%
- First reinfarctions
- 32, 19%
Mortality risk over time
- Initially increased mortality risk with invasive management (significant between days 131 and 175) shifted to a lower mortality risk over time
All reinfarctions (first and recurrent)
- Total reinfarctions
- 45
- Invasive strategy did not reduce the risk of reinfarction over time
- P = 0.72
Mortality longitudinal trajectory
- Higher mortality in the invasive group during the first 6 months and a reduction between 9 months and 3 years
- P = 0.05
- p for the entire time-dependent trajectory
Original publication
Effects of routine invasive management on reinfarction risk in older adults with frailty and non-ST-segment elevation myocardial infarction: a subanalysis of a randomised clinical trial. Heart. Published 8 February 2025. doi:10.
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