老年非ST段抬高型心肌梗死患者的侵入性治疗与保守治疗——来自SENIOR-RITA试验的见解
Invasive vs conservative management in elderly patients with NSTEMI- insights from the SENIOR-RITA trial.
作者信息
Narayan Pradeep
机构信息
Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, 124, EM Bypass, Mukundapur, Kolkata, 700099 India.
出版信息
Indian J Thorac Cardiovasc Surg. 2025 Jan;41(1):80-82. doi: 10.1007/s12055-024-01877-5. Epub 2024 Dec 2.
The SENIOR-RITA trial randomized 1,518 elderly Non-ST-segment elevation myocardial infarction (NSTEMI) patients to invasive or conservative strategies. The primary composite outcome of cardiovascular death or nonfatal Myocardial Infarction (MI) occurred in 25.6% of the invasive group versus 26.3% in the conservative group (p = 0.53), despite lower nonfatal MI rates with invasive treatment (11.7% vs 15.0%). Procedural complications were low (< 1%), though the invasive group had slightly higher bleeding and Transient Ischemic Attack (TIA) rates. The early 1-year benefit of the invasive approach was not maintained at 5 years, highlighting the need to individualize management in this complex, elderly population. The review discusses the strengths and weaknesses of the SENIOR-RITA (Older Patients with Non-ST-Segment Elevation Myocardial Infarction Randomized Interventional Treatment) trial.
SENIOR-RITA试验将1518例老年非ST段抬高型心肌梗死（NSTEMI）患者随机分为侵入性治疗组或保守治疗组。侵入性治疗组发生心血管死亡或非致命性心肌梗死（MI）这一主要复合结局的比例为25.6%，而保守治疗组为26.3%（p = 0.53），尽管侵入性治疗的非致命性MI发生率较低（11.7%对15.0%）。手术并发症发生率较低（<1%），不过侵入性治疗组的出血和短暂性脑缺血发作（TIA）发生率略高。侵入性治疗方法在1年时的早期获益在5年时未得到维持，这凸显了在这一复杂的老年人群中进行个体化管理的必要性。该综述讨论了SENIOR-RITA（非ST段抬高型心肌梗死老年患者随机介入治疗）试验的优缺点。
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