Coronary disease & ACSRandomised controlled trial
Invasive Treatment Strategy for Older Patients with Myocardial Infarction
- Randomised controlled trial
- prospective
- multicentre
- 48 UK sites
- 1:1 allocation
Authors' conclusion
In older adults with NSTEMI, an invasive strategy did not result in a significantly lower risk of cardiovascular death or nonfatal myocardial infarction (the composite primary outcome) than a conservative strategy over a median follow-up of 4.1 years.
Study context
- Population
- Patients ≥75 years with NSTEMI, including frail patients or those with a high burden of coexisting conditions; UK
- Participants
- 1,518 patients
- Comparison
- Invasive strategy vs conservative strategy
- Invasive strategyn = 753
- Conservative strategyn = 765reference
- Primary endpoint
- CV death or nonfatal MI (time-to-event)
- Follow-up
- Median 4.1 years
Primary result
CV death or nonfatal MI
Hazard ratio
0.94
95% CI 0.77–1.14
P = 0.53
Events by treatment group
Invasive strategy vs Conservative strategy
HR 0.94 (95% CI 0.77–1.14); P = 0.53
As reported in the abstract
Further findings
| Outcome | Invasive strategy | Conservative strategy | HR (95% CI) | |
|---|---|---|---|---|
| CV death | 15.8% | 14.2% | 1.11 (0.86–1.44) | |
| Nonfatal MI | 11.7% | 15.0% | 0.75 (0.57–0.99) | |
| 0.512Hazard ratio (log scale) |
Safety
Procedural complications
- Procedural complications
- less than 1% of the patients
Original publication
Invasive Treatment Strategy for Older Patients with Myocardial Infarction. N Engl J Med. Published 1 September 2024. doi:10.1056/nejmoa2407791
Summarised from the published abstract; every number is checked against it