Invasive vs Conservative Strategy for Frail Older Patients With Myocardial Infarction

Among frail older adults with non–ST-elevation myocardial infarction (NSTEMI), does an invasive strategy reduce the risk of cardiovascular death or nonfatal myocardial infarction (MI) compared with a conservative strategy?In this subgroup analysis of 469 frail patients from the SENIOR-RITA randomized clinical trial, an invasive strategy did not reduce the risk of cardiovascular death or nonfatal MI. A significant interaction was found between treatment and frailty severity such that patients at the highest levels of frailty had a potential signal for harm with routine invasive strategy.Among frail older adults with NSTEMI, an invasive strategy provided no benefit over conservative management and may be associated with worse outcomes at higher levels of frailty, highlighting the importance of incorporating frailty assessment into clinical decision-making.

Corresponding Author: Vijay Kunadian MD, Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, 4th Floor, William Leech Building, Newcastle upon Tyne NE2 4HH, United Kingdom (vijay.kunadian@newcastle.ac.uk).

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