Elderly patients with acute coronary syndrome frequently present with atypical symptoms and are at high risk for both ischemic and bleeding complications, requiring individualized care.
Does guideline-directed medical therapy and early invasive strategy improve outcomes in elderly patients with acute coronary syndrome?
Age alone should not be a reason to withhold potentially lifesaving invasive procedures and guideline-directed medical therapies in elderly patients with ACS, provided dosages are meticulously adjusted.
The clinical evidence for treatment of acute coronary syndrome (ACS) in the elderly is less robust than in patients younger than 75 years. The elderly have the highest incidence of cardiovascular disease and frequently present with ACS. This number can be expected to increase over time because society is aging. Older adults often sustain unfavorable outcomes from ACS because of atypical presentation and delay in recognition. In addition, elderly patients commonly do not receive optimal guideline-directed ACS treatment. Owing to their high baseline risk of ischemic complications, the elderly also fare worse even with optimal ACS treatment as they frequently have more complex coronary disease, more comorbidities, less cardiovascular reserve, and a higher risk of treatment complications. They are also subjected to a broader range of pharmacologic treatment. Treatment complications can be mitigated to some extent by meticulous dose adjustment of antithrombotic and adjunctive therapies. While careful transitions of care and appropriate utilization of post-discharge secondary preventive measures are important in ACS patients of all ages, the elderly are more vulnerable to system errors and thus deserve special attention from the clinician.
Engberding et al. (Mon,) conducted a review in Acute Coronary Syndrome. Guideline-directed medical therapy and revascularization was evaluated. Elderly patients with acute coronary syndrome frequently present with atypical symptoms and are at high risk for both ischemic and bleeding complications, requiring individualized care.