EVAOLD trial advises against selective invasive strategy for older heart attack patients

The European Society of Cardiology (ESC) Congress 2026 featured the EVAOLD trial, which examined the management of older patients suffering from the most common type of myocardial infarction. The study compared a routine invasive strategy—early coronary angiography and potential revascularisation—with a more selective, symptom‑driven approach. Results indicated that the routine invasive protocol did not lead to worse outcomes and should not be replaced by a selective strategy in this patient group.

Key findings revealed no significant difference in major adverse cardiac events, mortality, or rehospitalisation rates between the two approaches over a 12‑month follow‑up. Importantly, the routine invasive group experienced a higher rate of timely revascularisation, which may explain the comparable outcomes despite the older age of participants. The trial’s authors emphasized that these results support maintaining current guidelines that advocate early invasive management for older adults presenting with ST‑segment‑elevation myocardial infarction.

In conclusion, the EVAOLD trial reinforces the value of a routine invasive strategy in elderly patients with the most common heart‑attack presentation. The evidence suggests that a selective, less aggressive approach offers no additional benefit and could risk delayed treatment. ESC members and clinicians are encouraged to continue applying established invasive protocols for this high‑risk population.