Evidence map›Paper›PMID 32861307›Full record

ArticleLancet (London, England)2020

Invasive versus non-invasive management of older patients with non-ST elevation myocardial infarction (SENIOR-NSTEMI): a cohort study based on routine clinical data.

Amit Kaura, Jonathan A C Sterne, Adam Trickey, Sam Abbott, Abdulrahim Mulla, Benjamin Glampson, Vasileios Panoulas, Jim Davies, Kerrie Woods, Joe Omigie and 18 more

Open access · hybridAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Lancet (London, England), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 6 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
53citing papers in PubMed, 6 pooled it
9.9field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

53 citing papers in PubMed, 6 syntheses or guidelines pooled it, 111 citations in OpenAlex.

  1. Pooled it
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  12. Observational
  13. The impact of aging on acute coronary syndromes: an EHR-based analysis.Netherlands heart journal : monthly journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation · 2026
    Article
  14. Article
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  16. Review
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  19. Review
  20. Treatment of non-ST-segment elevation myocardial infarction in the elderly: the SENIOR-RITA trial.European heart journal supplements : journal of the European Society of Cardiology · 2025
    Article
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

28 authors at 12 institutions in 1 country.

Amit KauraNational Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, UK.
Jonathan A C SterneNational Institute for Health Research Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK; Department of Population Health Sciences, University of Bristol, Bristol, UK.
Adam TrickeyDepartment of Population Health Sciences, University of Bristol, Bristol, UK.
Sam AbbottDepartment of Population Health Sciences, University of Bristol, Bristol, UK.
Abdulrahim MullaNational Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, UK.
Benjamin GlampsonNational Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, UK.
Vasileios PanoulasNational Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, UK.
Jim DaviesNational Institute for Health Research Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Kerrie WoodsNational Institute for Health Research Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Joe OmigieNational Institute for Health Research King's Biomedical Research Centre, King's College London, Guy's and St Thomas' NHS Foundation Trust and King's College Hospital NHS Foundation Trust, London, UK.
Anoop D ShahNational Institute for Health Research University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK.
Keith M ChannonNational Institute for Health Research Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Jonathan N WeberNational Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, UK.
Mark R ThurszNational Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, UK.
Paul ElliottNational Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, UK; Institute of Health Informatics, Health Data Research UK, London, UK.
Harry HemingwayNational Institute for Health Research University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK; Institute of Health Informatics, Health Data Research UK, London, UK.
Bryan WilliamsNational Institute for Health Research University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK.
Folkert W AsselbergsNational Institute for Health Research University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK.
Michael O'SullivanNational Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Graham M LordNational Institute for Health Research Manchester Biomedical Research Centre, University of Manchester and Manchester University NHS Foundation Trust, Manchester, UK.
Narbeh MelikianNational Institute for Health Research King's Biomedical Research Centre, King's College London, Guy's and St Thomas' NHS Foundation Trust and King's College Hospital NHS Foundation Trust, London, UK.
Thomas JohnsonNational Institute for Health Research Bristol Biomedical Research Centre, University of Bristol and University Hospitals Bristol NHS Foundation Trust, Bristol, UK.
Darrel P FrancisNational Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, UK.
Ajay M ShahNational Institute for Health Research King's Biomedical Research Centre, King's College London, Guy's and St Thomas' NHS Foundation Trust and King's College Hospital NHS Foundation Trust, London, UK; Institute of Health Informatics, Health Data Research UK, London, UK.
Divaka PereraNational Institute for Health Research King's Biomedical Research Centre, King's College London, Guy's and St Thomas' NHS Foundation Trust and King's College Hospital NHS Foundation Trust, London, UK.
Rajesh KharbandaNational Institute for Health Research Oxford Biomedical Research Centre, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
Riyaz S PatelNational Institute for Health Research University College London Biomedical Research Centre, University College London and University College London Hospitals NHS Foundation Trust, London, UK.
Jamil MayetNational Institute for Health Research Imperial Biomedical Research Centre, Imperial College London and Imperial College Healthcare NHS Trust, London, UK. Electronic address: j.mayet@imperial.ac.uk.
National Institute for Health Research · GBUniversity of Bristol · GBImperial College Healthcare NHS Trust · GBImperial College London · GBKing's College London · GBUniversity College London · GBCambridge University Hospitals NHS Foundation Trust · GBHealth Data Research UK · GBKing's College Hospital NHS Foundation Trust · GBNIHR Imperial Biomedical Research Centre · GBUniversity College London Hospitals NHS Foundation Trust · GBUniversity of Oxford · GB

Funding

British Heart Foundation FS/20/18/34972British Heart Foundation SP/17/16/33519Medical Research Council G0902393Medical Research Council MC_PC_13041Medical Research Council MR/K006584/1Medical Research Council MR/M501633/2
6 · The paper itself

Abstract

backgroundPrevious trials suggest lower long-term risk of mortality after invasive rather than non-invasive management of patients with non-ST elevation myocardial infarction (NSTEMI), but the trials excluded very elderly patients. We aimed to estimate the effect of invasive versus non-invasive management within 3 days of peak troponin concentration on the survival of patients aged 80 years or older with NSTEMI.

methodsRoutine clinical data for this study were obtained from five collaborating hospitals hosting NIHR Biomedical Research Centres in the UK (all tertiary centres with emergency departments). Eligible patients were 80 years old or older when they underwent troponin measurements and were diagnosed with NSTEMI between 2010 (2008 for University College Hospital) and 2017. Propensity scores (patients' estimated probability of receiving invasive management) based on pretreatment variables were derived using logistic regression; patients with high probabilities of non-invasive or invasive management were excluded. Patients who died within 3 days of peak troponin concentration without receiving invasive management were assigned to the invasive or non-invasive management groups based on their propensity scores, to mitigate immortal time bias. We estimated mortality hazard ratios comparing invasive with non-invasive management, and compared the rate of hospital admissions for heart failure.

findingsOf the 1976 patients with NSTEMI, 101 died within 3 days of their peak troponin concentration and 375 were excluded because of extreme propensity scores. The remaining 1500 patients had a median age of 86 (IQR 82-89) years of whom (845 [56%] received non-invasive management. During median follow-up of 3·0 (IQR 1·2-4·8) years, 613 (41%) patients died. The adjusted cumulative 5-year mortality was 36% in the invasive management group and 55% in the non-invasive management group (adjusted hazard ratio 0·68, 95% CI 0·55-0·84). Invasive management was associated with lower incidence of hospital admissions for heart failure (adjusted rate ratio compared with non-invasive management 0·67, 95% CI 0·48-0·93).

interpretationThe survival advantage of invasive compared with non-invasive management appears to extend to patients with NSTEMI who are aged 80 years or older.

fundingNIHR Imperial Biomedical Research Centre, as part of the NIHR Health Informatics Collaborative.

Indexed as

Aged, 80 and overAge FactorsCohort StudiesFemaleHospitalizationHumansLogistic ModelsMaleNon-ST Elevated Myocardial InfarctionPropensity ScoreSurvival RateTroponinUnited KingdomTroponin

Identifiers

PMID32861307
PMCPMC7456783
OpenAlexW3080719260

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.