Angiographic Characteristics of Older Patients with Non-ST Elevation Myocardial Infarction Undergoing Invasive Strategy
Graziella Pompei, Francesca Rubino, Kenny Jenkins, Hanna Ratcovich, David Austin, Shrilla Banerjee, Gill Louise Buchanan, Shahid Junejo, Abdul Nasser, Nehal Hussein, Jolanta Sobolewska, Timothy Williams, Stuart Hood, Awsan Noman, Akhlaque Uddin, Manas Sinha, Robert Butler, John Irving, Robert F Storey, David E Newby, Keith A A Fox, Stuart Pocock, Vijay KunadianAbstract
Background
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
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 (QCA) at Newcastle University angiographic core laboratory using QAngio® XA Medis.
Results
Of 680 patients undergoing angiography, QCA 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 higher prevalence of type C lesions, bifurcation, ostial lesions, and presence of collaterals. Overall, 330 patients (49.5%) underwent PCI, which was successful in 96.5% with minimal complications.
Conclusions
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 emphasising the importance of a holistic patient-centred care for older adults.