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. 2021 Dec 17;2(1):oeab044.
doi: 10.1093/ehjopen/oeab044. eCollection 2022 Jan.

Is the contemporary care of the older persons with acute coronary syndrome evidence-based?

Greg B Mills  1 , Hanna Ratcovich  1   2 , Jennifer Adams-Hall  3 , Benjamin Beska  1   3 , Emma Kirkup  3 , Daniell E Raharjo  1   4 , Murugapathy Veerasamy  5 , Chris Wilkinson  3   6 , Vijay Kunadian  1   3
Affiliations

Is the contemporary care of the older persons with acute coronary syndrome evidence-based?

Greg B Mills et al. Eur Heart J Open. .

Erratum in

Abstract

Globally, ischaemic heart disease is the leading cause of death, with a higher mortality burden amongst older adults. Although advancing age is associated with a higher risk of adverse outcomes following acute coronary syndrome (ACS), older patients are less likely to receive evidence-based medications and coronary angiography. Guideline recommendations for managing ACS are often based on studies that exclude older patients, and more contemporary trials have been underpowered and produced inconsistent findings. There is also limited evidence for how frailty and comorbidity should influence management decisions. This review focuses on the current evidence base for the medical and percutaneous management of ACS in older patients and highlights the distinct need to enrol older patients with ACS into well-powered, large-scale randomized trials.

Keywords: Acute coronary syndrome; Coronary angiography; Myocardial infarction; Older adults; Percutaneous intervention.

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Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Current European Society of Cardiology recommendations on the management of older patients with acute coronary syndrome. This figure use illustrations from Servier Medical Art Image Bank. These are licensed under a Creative Commons Attribution 3.0 Unported License that permits adaptation and sharing of the material for any purpose. Full license details can be found at https://creativecommons.org/licenses/by/3.0/
Figure 2
Figure 2
Evidence on the management of older patients with ST-elevation myocardial infarction.
Figure 3
Figure 3
Evidence on the management of older patients with non-ST-elevation acute coronary syndrome.
Figure 4
Figure 4
Limitations of studies used as a basis for guideline recommendations in older patients with non-ST-elevation acute coronary syndrome. This figure use illustrations from Servier Medical Art Image Bank. These are licensed under a Creative Commons Attribution 3.0 Unported License that permits adaptation and sharing of the material for any purpose. Full license details can be found at https://creativecommons.org/licenses/by/3.0/
Figure 5
Figure 5
Summary of the evidence base for considerations in patient-centred, informed choices, and decision-making as recommended by National Institute for Health and Care Excellence, European Society of Cardiology, and AHA/ACC guidelines. Specifically, guidance on how clinicians should consider these factors are missing. This figure use illustrations from Servier Medical Art Image Bank. These are licensed under a Creative Commons Attribution 3.0 Unported License that permits adaptation and sharing of the material for any purpose. Full license details can be found at https://creativecommons.org/licenses/by/3.0/
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