Invasive vs Non-invasive Management of Elderly Patients with Non-ST-Elevation Myocardial Infarction (NSTEMI)

Management of non-ST-elevation myocardial infarction (NSTEMI) in older patients remains challenging, particularly following the SENIOR-RITA trial, which did not demonstrate a mortality benefit with invasive management. This audit aims to compare outcomes between invasive and non-invasive management strategies in patients aged ≥75 years presenting with NSTEMI at Connolly Hospital, Blanchardstown, and to relate these findings to European Society of Cardiology (ESC) guidelines and SENIOR-RITA.

A retrospective audit of 50 NSTEMI patients aged ≥75 admitted from 2020 to 2024 examined mortality, length of stay, complications, and readmission rates. Survival was analysed with Kaplan-Meier.

Of 50 patients, 29 (58%) underwent invasive management. Baseline features were similar between the invasive and conservative groups, though frailty was infrequently documented with formal assessment tools. Invasive patients had shorter stays (p=0.041) and lower 6-month mortality (14.3% vs 85.7%, p=0.03254). Kaplan-Meier analysis showed higher survival in the invasive group. Complication and readmission rates were similar.

Invasive management was associated with a shorter hospital stay and lower mortality. However, the findings should be interpreted cautiously, given the retrospective design and possible selection bias. These findings do not contradict the SENIOR-RITA trial, and local practice aligned with ESC guidelines.