Revascularisation or medical therapy in elderly patients with acute anginal syndromes (RINCAL) a randomised trial
journal contributionposted on 2023-06-09, 22:33 authored by Adam de Belder, Aung Myat, Jonathan Blaxill, Peter Haworth, Peter O’Kane, Robert Hatrick, Rajesh Aggarwal, Andrew Davie, William Smith, Robert Gerber, Jonathan Byrne, Dawn Adamson, Fraser Witherow, Osama Alsanjari, Juliet Wright, Derek R Robinson, David Hildick-Smith
Aims: To determine whether an intervention-guided strategy is superior to optimal medical therapy (OMT) for treating non-ST-elevation myocardial infarction (NSTEMI) in the elderly. Methods and results: Patients (=80 years, chest pain, ischaemic ECG, and elevated troponin) were randomised 1:1 to an invasive strategy plus OMT versus OMT alone. The combined primary endpoint was all-cause mortality and non-fatal myocardial re-infarction at 1 year. We enrolled 251 patients (n=125 invasive vs. n=126 conservative) from May 2014 to September 2018. Almost half were female. The trial was terminated prematurely due to slow recruitment. A Kaplan-Meier estimate of event-free survival revealed no difference in the primary combined endpoint (invasive 18.5% [23/124] vs. conservative 22.2% [28/126]; p=0.39) or in all-cause mortality alone (invasive 10.5% [13/124] vs. conservative 11.1% [14/126]; p=0.88). There was less angina at 3 months (p<0.001) in the intervention arm. Non-fatal reinfarction (invasive 9.7% [12/124] vs. conservative 14.3% [18/126]; p=0.22) and unplanned revascularisation (invasive 1.6% [2/124] vs. conservative 6.4% [8/126]; p=0.10) were non-significantly more frequent after OMT alone. Conclusion: The trial was underpowered to provide a definitive conclusion regarding the primary endpoint. An intervention-guided strategy did, however, result in less angina, reinfarction and unplanned revascularisation but did not improve survival.
- Accepted version
Department affiliated with
- Clinical and Experimental Medicine Publications
Full text available