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Review
. 2024 Oct 5;13(19):5935.
doi: 10.3390/jcm13195935.

Acute Coronary Syndrome in Elderly Patients: How to Tackle Them?

Fabiana Lucà  1 , Felicita Andreotti  2 , Carmelo Massimiliano Rao  1 , Giuseppe Pelaggi  1 , Mariacarmela Nucara  1 , Carlo Ammendolea  3 , Laura Pezzi  4 , Nadia Ingianni  5 , Adriano Murrone  6 , Donatella Del Sindaco  7 , Maddalena Lettino  8 , Giovanna Geraci  9 , Carmine Riccio  10 , Claudio Bilato  11 , Furio Colivicchi  12 , Massimo Grimaldi  13 , Fabrizio Oliva  14 , Michele Massimo Gulizia  15 , Iris Parrini  16 ; Cardiogeriatrics Working Group of Italian Association of Hospital Cardiologists and Multi-Specialist and Multi-Integrated Approach for in Cardiology Working Group (ANMCO)
Affiliations
Review

Acute Coronary Syndrome in Elderly Patients: How to Tackle Them?

Fabiana Lucà et al. J Clin Med. .

Abstract

Elderly patients diagnosed with acute coronary syndromes (ACS) represent a growing demographic population. These patients typically present more comorbidities and experience poorer outcomes compared to younger patients. Furthermore, they are less frequently subjected to revascularization procedures and are less likely to receive evidence-based medications in both the short and long-term periods. Assessing frailty is crucial in elderly patients with ACS because it can influence management decisions, as well as risk stratification and prognosis. Indeed, treatment decisions should consider geriatric syndromes, frailty, polypharmacy, sarcopenia, nutritional deficits, prevalence of comorbidities, thrombotic risk, and, at the same time, an increased risk of bleeding. Rigorous clinical assessments, clear revascularization criteria, and tailored approaches to antithrombotic therapy are essential for guiding personalized treatment decisions in these individuals. Assessing frailty helps healthcare providers identify patients who may benefit from targeted interventions to improve their outcomes and quality of life. Elderly individuals who experience ACS remain significantly underrepresented and understudied in randomized controlled trials. For this reason, the occurrence of ACS in the elderly continues to be a particularly complex issue in clinical practice, and one that clinicians increasingly have to address, given the general ageing of populations. This review aims to address the complex aspects of elderly patients with ACS to help clinicians make therapeutic decisions when faced with such situations.

Keywords: ACS; NSTEMI; PCI; ST-segment elevation myocardial infarction; STEMI; acute coronary syndrome; elderly; non-ST-segment elevation myocardial infarction; percutaneous coronary intervention.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Age-Related Cardiovascular Changes. ↑: increase of, ↓ reduction of.
Figure 2
Figure 2
When determining the treatment strategy for ACS in elderly patients, it is essential to consider functional and cognitive capacity, quality of life, comorbidities, risk of complications, hemodynamic status, electrical and clinical stability and assessing anatomic and procedural risk. Taking these factors into account helps to personalize the treatment approach. Abb: ACS; Acute Coronary Syndrome; VHD: valvular heart disease.
Figure 3
Figure 3
Geriatric assessment: Geriatric syndromes increase in elderly in whom multimorbidity, polypharmacy frailty, cognitive impairment, and physical decline often occur, leading to a higher risk of adverse outcomes. ↓: reduction of.
See this image and copyright information in PMC

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