Angiographic characteristics of older patients with non-ST elevation myocardial infarction undergoing invasive strategy: A pre-specified analysis from the SENIOR-RITA trial

Aims

In the SENIOR-RITA trial, among older adults with non-ST-elevation myocardial infarction (NSTEMI), an invasive strategy did not reduce the composite outcome of cardiovascular death or non-fatal myocardial infarction compared with a conservative strategy over a median follow-up of 4.1 years.

Objectives

To describe the angiographic characteristics of patients randomized to the invasive arm.

Methods and results

SENIOR-RITA was a prospective, multicentre, randomized controlled trial recruiting NSTEMI patients aged ≥75 years. From November 2016 to March 2023, 1518 patients from 48 UK sites were randomized 1:1 to an invasive or conservative strategy. Procedural data were collected, and angiographic data were analysed using quantitative coronary angiography at the Newcastle University angiographic core laboratory using QAngio® XA Medis. Of 680 patients undergoing angiography, quantitative coronary angiography analysis was performed in 667 participants. Obstructive coronary artery disease was found in 76.8%, and 13% had prior coronary surgical revascularization. A total of 1173 lesions were identified. Most lesions (29.5%) were classified as type B2 according to the ACC/AHA classification. Lesions in patients not receiving percutaneous coronary intervention (PCI) were angiographically more complex than those treated with PCI, with a higher prevalence of type C lesions, bifurcation, ostial lesions, and the presence of collaterals. Overall, 330 patients (49.5%) underwent PCI, which was successful in 96.5% with minimal complications.

Conclusion

The SENIOR-RITA angiography sub-study is the largest subgroup analysis to date in older NSTEMI adults, providing important insights into the angiographic characteristics and emphasizing the importance of a holistic, patient-centred care for older adults.