{"id":"e2f1b5a3c89d","type":"article","url":"https://hartvaat.nl/2024/11/07/invasieve-strategie-bij-ouderen-met-mi-gerandomiseerde-trial-nejm/","title":"Invasieve strategie bij ouderen met MI: gerandomiseerde trial — NEJM","title_en":"Invasive Treatment Strategy for Older Patients with Myocardial Infarction.","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"The New England journal of medicine","doi":"10.1056/NEJMoa2407791","source_url":"https://doi.org/10.1056/NEJMoa2407791","authors":["Vijay Kunadian","Helen Mossop","Carol Shields","Michelle Bardgett","Philippa Watts","M Dawn Teare","Jonathan Pritchard","Jennifer Adams-Hall","Craig Runnett","David P Ripley","Justin Carter","Julie Quigley","Justin Cooke","David Austin","Jerry Murphy","Damian Kelly","James McGowan","Murugapathy Veerasamy","Dirk Felmeden","Hussain Contractor","Sanjay Mutgi","John Irving","Steven Lindsay","Gavin Galasko","Kelvin Lee","Ayyaz Sultan","Amardeep G Dastidar","Shazia Hussain","Iftikhar Ul Haq","Mark de Belder","Martin Denvir","Marcus Flather","Robert F Storey","David E Newby","Stuart J Pocock","Keith A A Fox"],"significance":9,"published":"2024-11-07","source_date":"2024-11-07","image":"","kennis":["https://hartvaat.nl/kennis/cardiometabool/bloedsuikerdoelen-cardiovasculair/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"This NEJM trial demonstrated that an invasive treatment strategy in patients aged 80 years or older with non-STEMI significantly reduced the composite of MI, urgent revascularization, stroke, and death compared with conservative management. The results support active intervention even in the oldest-old MI population.","created":"2026-07-03T10:31:17Z","updated":"2026-07-03T13:30:18Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"NEJM-trial toonde dat een invasieve behandelstrategie bij ouderen (≥80 jaar) met MI de uitkomsten verbetert. Het voordeel van revascularisatie houdt stand op hoge leeftijd, wat terughoudendheid op basis van leeftijd alleen tegenspreekt.","abstract_original":"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.)."}