How do you approach revascularization in patients over 75 years with NSTEMI, given recent evidence from the SENIOR-RITA trial that an invasive strategy does not significantly reduce cardiovascular events compared to a conservative strategy?

The Senior-Rita trial was a randomized trial of nstemi patients over the age of 75 randomized to conservative therapy versus an invasive strategy plus optimal medical therapy. Non-fatal MI was more common in the conservative strategy group but overall a primary outcome event occurred in 25-26% in both groups over 4-year follow-up. Notably, 32% of the patients were characterized as frail.

How should cardiologists use these trial results in their practice? The one thing I am sure of is NOT to take this trial to mean that an invasive approach is a mistake in EVERY older patient. It should make us think twice about it though, especially if the degree of ischemia is small or there is cognitive or physical infirmity. Being aggressive in elderly pa...