BACKGROUND Whether a conservative strategy of medical therapy alone or a strategy of medical therapy plus invasive treatment is more beneficial in older adults with non-ST-segment elevation myocardial infarction (NSTEMI) remains unclear. METHODS We conducted a prospective, multicenter, randomized trial involving patients 75 years of age or older with NSTEMI at 48 sites in the United Kingdom. The patients were assigned in a 1:1 ratio to a conservative strategy of the best available medical therapy or an invasive strategy of coronary angiography and revascularization plus the best available medical therapy. Patients who were frail or had a high burden of coexisting conditions were eligible. The primary outcome was a composite of death from cardiovascular causes (cardiovascular death) or nonfatal myocardial infarction assessed in a time-to-event analysis. RESULTS A total of 1518 patients underwent randomization; 753 patients were assigned to the invasive-strategy group and 765 to the conservative-strategy group. The mean age of the patients was 82 years, 45% were women, and 32% were frail. A primary-outcome event occurred in 193 patients (25.6%) in the invasive-strategy group and 201 patients (26.3%) in the conservative-strategy group (hazard ratio, 0.94; 95% confidence interval [CI], 0.77 to 1.14; P = 0.53) over a median follow-up of 4.1 years. Cardiovascular death occurred in 15.8% of the patients in the invasive-strategy group and 14.2% of the patients in the conservative-strategy group (hazard ratio, 1.11; 95% CI, 0.86 to 1.44). Nonfatal myocardial infarction occurred in 11.7% in the invasive-strategy group and 15.0% in the conservative-strategy group (hazard ratio, 0.75; 95% CI, 0.57 to 0.99). Procedural complications occurred in less than 1% of the patients. CONCLUSIONS 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. (Funded by the British Heart Foundation; BHF SENIOR-RITA ISRCTN Registry number, ISRCTN11343602.).

中文翻译：

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老年心肌梗死患者的侵入性治疗策略。


背景：对于患有非 ST 段抬高型心肌梗死 （NSTEMI） 的老年人，尚不清楚单独药物治疗的保守策略还是药物治疗加侵入性治疗的策略更有益。方法 我们进行了一项前瞻性、多中心、随机试验，涉及在英国 48 个地点的 75 岁或以上的 NSTEMI 患者。患者以 1：1 的比例被分配到最佳可用药物治疗的保守策略或冠状动脉造影和血运重建的侵入性策略加上最佳可用药物治疗。虚弱或共存疾病负担沉重的患者符合条件。主要结局是在事件发生时间分析中评估的心血管原因导致的死亡 （心血管死亡） 或非致命性心肌梗死的复合结局。结果 共有 1518 例患者接受了随机分组;753 例患者被分配到侵入性策略组，765 例被分配到保守策略组。患者的平均年龄为 82 岁，45% 为女性，32% 为虚弱。侵入性策略组 193 例患者 （25.6%） 和保守策略组 201 例患者 （26.3%） 发生主要结局事件 （风险比，0.94;95% 置信区间 [CI]，0.77 至 1.14;P = 0.53），中位随访 4.1 年。侵入性策略组和 14.2% 的患者发生心血管死亡 （风险比，1.11;95% CI，0.86 至 1.44）。非致死性心肌梗死在侵袭策略组中发生率为 11.7%，保守策略组为 15.0%（风险比，0.75;95% CI，0.57 至 0.99）。不到 1% 的患者发生手术并发症。 结论在患有 NSTEMI 的老年人中，在中位随访 4.1 年期间，与保守策略相比，侵入性策略未显著降低心血管死亡或非致命性心肌梗死 （复合主要结局） 的风险。（由英国心脏基金会资助;BHF SENIOR-RITA ISRCTN 登记号，ISRCTN11343602.）。