A Bayesian analysis of invasive treatment strategies for elderly patients with acute coronary syndromes

Until recently, only small-scale randomised controlled trials (RCTs) had evaluated the impact of invasive approaches in elderly patients with acute coronary syndromes (ACS). To address the inherent limitations of these smaller trials, a comprehensive individual participant data (IPD) meta-analysis was conducted1. Following this meta-analysis, the SENIOR-RITA trial2, with a sample size comparable to the total sample of the IPD meta-analysis1 was published. This RCT2 found no evidence that an invasive strategy reduces cardiovascular death or non-fatal myocardial infarction (MI) compared to a conservative approach in older patients with non-ST-segment elevation myocardial infarction. Here, we employ this large RCT2 to update the meta-analysis1 within a Bayesian framework, providing a probabilistic perspective on the interpretation of the estimated effects.

We considered the comprehensive IPD meta-analysis of 6 small-scale RCTs (sample sizes ranging from 106-457, with a total number of 1,479 individuals) evaluating the impact of percutaneous coronary intervention (PCI) in elderly ACS patients1. The recently published SENIOR-RITA trial2 included 1,518 patients ≥75 years old with ACS. Patients in all these trials were randomised to an...