Age Ageing. 2026 Oct 31;55(11):afag330. doi: 10.1093/ageing/afag330.
ABSTRACT
BACKGROUND: Older adults with non-ST-segment elevation myocardial infarction (NSTEMI) and cognitive impairment experience higher cardiovascular risk than patients with normal cognition. It remains unclear how cognition should influence whether older adults receive an invasive or conservative treatment strategy.
OBJECTIVES: To compare an invasive and conservative treatment strategy among older adults with NSTEMI and cognitive impairment.
METHODS: This study is a pre-specified analysis of the SENIOR-RITA randomised controlled trial. Cognition was measured at randomisation using the Montreal Cognitive Assessment (MoCA). Patients were followed up for a median of 4.1 years postrandomisation. The primary outcome was a composite of time to cardiovascular death or nonfatal myocardial infarction (MI).
RESULTS: MoCA was available for 1455 patients (95.8%) who underwent randomisation. Within the cognitively impaired group (909 patients), the primary outcome occurred in 116 patients (26.8%) in the invasive group and in 141 patients (29.6%) in the conservative group (hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.66 to 1.10; P = 0.20). Nonfatal MI occurred in 48 patients (11.1%) in the invasive group and in 75 patients (15.8%) in the conservative group (HR 0.64; 95% CI, 0.44 to 0.92). However, there was no interaction between treatment strategy and cognition.
CONCLUSIONS: Among those with evidence of cognitive impairment at randomisation, an invasive treatment strategy did not reduce the primary composite outcome of cardiovascular death or nonfatal MI, and there was no evidence of treatment effect heterogeneity based on cognition. The reduction in nonfatal MI events among those with cognitive impairment should be interpreted as an exploratory finding.
PMID:43016171 | DOI:10.1093/ageing/afag330
