EvidenzUpdate · Apr 21, 2026
Frailty, formulas, and subtle effects – (Late) evidence quickies, calendar week 16
By Nößler D
Sunday evening Tuesday night is (belated) quickie time. Once again two days late. Sorry. But a little less today (only four). Here you go. And (unfortunately) we are once again very, actually exclusively, cardiovascular. Oops. Nevertheless: Enjoy, and hopefully an interesting read! And have a good (rest of the) week! 🫀 NSTEMI, frail and old: Better not on the “table” In patients aged ≥ 75 with non-ST-elevation myocardial infarction and frailty (Fried score ≥ 3), the invasive (PCI) strategy offers no measurable benefit over optimal medication. In the frailest patients, there may even be more harm. Bottom line: Frailty assessment before deciding on catheterization is mandatory. Caution: exploratory subgroup analysis, really only hypothesis-generating. 🎈 SCORE2-HF, a new calculator for heart failure risk The SCORE2 Writing Group of the European Society of Cardiology (ESC) has, for the first time, developed a model for estimating 10- and 30-year heart failure risk from 8 routine parameters (C-index 0.83–0.87). Methodologically, this is sound and interesting, including to play around with. But: no data from Germany in the validation, and this most certainly must not become a trigger for primary preventive treatment. 🧠 Factor XIa inhibitor for recurrence prevention after stroke just around the corner The not-yet-approved (!) asundexian significantly reduced recurrent ischemic strokes in the manufacturer-funded OCEANIC-STROKE phase III trial (NNT ~ 53/year) without an increased bleeding risk. No mortality benefit, no antidote, Bayer-funded. Also: Not yet approved. Biologically interesting, but for now only something to keep in the (back of your) mind. 🩸 Stent for PTS: A tiny step overshadowed by bleeding Stenting for postthrombotic syndrome showed a statistically significant but clinically modest VCSS benefit in the C-TRACT trial, additionally bought at the cost of a tripled bleeding risk (NNH 13). The study has a highly selected US cohort, only 6 months of follow-up. The method is certainly not for widespread use, at most a future option for severe treatment-refractory PTS. And now for the details … Rubino et al., JAMA Network Open 2026, 1 subgroup analysis of the SENIOR-RITA trial from 🇬🇧 ( ISRCTN11343602 ), together with an accompanying commentary 2 🎯 In brief: In frail very old patients (≥ 75 years) with non-ST-elevation myocardial infarction (NSTEMI), the invasive strategy (PCI and revascularization if necessary) offers no measurable benefit over conservative drug therapy. In the frailest patients, there may even be more harm. Therefore: A frailty assessment before deciding on a place in the catheterization laboratory is not a nice-to-have, but should be mandatory.