What question did this study set out to answer?

This study aims to identify prognostic factors and evaluate the impact of management strategies on outcomes in elderly patients with acute coronary syndrome.

April 25, 2026

Gender Differences in Risk Factors, Management, and Outcomes of Elderly Patients With Acute Coronary Syndrome: The Interplay of Frailty

Key Result

Frailty independently predicted mortality in elderly ACS patients, while PCI for NSTE-ACS reduced in-hospital mortality (3.5% vs. 8.4%) but yielded no significant 1-year survival benefit.

Key Points

This study aims to identify prognostic factors and evaluate the impact of management strategies on outcomes in elderly patients with acute coronary syndrome.
Retrospective analysis of ACS patients aged ≥ 75 years who underwent coronary angiography.
Frailty assessed using the Rockwood Clinical Frailty Scale within the first 48 hours of admission.
Comparison of sex-related differences, treatment strategies, and predictors of outcomes.
627 patients included; 46% women, with 66.8% having non-ST elevation ACS (NSTE-ACS).
Higher in-hospital mortality in STEMI patients (19.7% vs. 5.7%) and MACCE rates (50.5% vs. 22%; both p < 0.001).
PCI showed lower in-hospital mortality in NSTE-ACS (3.5% vs. 8.4%; p = 0.040) but higher adverse event rates without long-term mortality reduction.

Structured PICO

Does percutaneous coronary intervention improve all-cause mortality in elderly patients (≥75 years) with acute coronary syndrome compared to conservative medical therapy?

Population

627 consecutive acute coronary syndrome (ACS) patients aged ≥ 75 years who underwent coronary angiography (46% women, 66.8% NSTE-ACS)

Intervention

Percutaneous coronary intervention (PCI)

Comparator

Conservative/medical therapy

Outcome

All-cause mortality (in-hospital and 1-year)hard clinical

In elderly ACS patients, frailty is a strong predictor of mortality, and while PCI may reduce in-hospital mortality in NSTE-ACS, it does not significantly improve 1-year survival compared to conservative management.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

ABSTRACT Backgrounds Older adults constitute a growing proportion of patients presenting with acute coronary syndrome (ACS); optimal management remains uncertain due to comorbidities, frailty, procedure‐related complications. Aim This study aimed to identify prognostic determinants and to evaluate the impact of invasive management strategies on short‐ and long‐term outcomes in elderly patients with ACS. Methods We retrospectively analyzed consecutive ACS patients aged ≥ 75 years who underwent coronary angiography. Frailty was assessed within the first 48 h of admission using the Rockwood Clinical Frailty Scale (CFS). Sex‐related differences, frailty, treatment strategies (percutaneous coronary intervention PCI vs. conservative/medical therapy), predictors of short‐ and long‐term outcomes were assessed. The primary endpoint was all‐cause mortality; secondary endpoints included major adverse cardiac and cerebrovascular events (MACCEs). Results A total of 627 patients were included (46% women), with non–ST‐elevation ACS (NSTE‐ACS) as the predominant presentation (66.8%). Patients presenting with ST‐elevation myocardial infarction (STEMI) experienced significantly higher in‐hospital mortality (19.7% vs.5.7%) and MACCEs rates (50.5% vs. 22%; both p < 0.001) compared with those with NSTE‐ACS. In‐hospital and 1‐year mortality did not differ by sex. Shock, frailty, contrast‐induced nephropathy, peak troponin levels as independent predictors of in‐hospital mortality, whereas frailty, reduced left ventricular ejection fraction, peak troponin independently predicted long‐term mortality. Among patients with NSTE‐ACS, PCI was associated with lower in‐hospital mortality (3.5% vs. 8.4%; p = 0.040) but higher rates of in‐hospital and long‐term adverse events, without a significant reduction in 1‐year mortality. Conclusions Frailty is a dominant determinant of both short‐ and long‐term mortality and should be systematically incorporated into early risk stratification. A selective, frailty‐guided invasive strategy may improve early survival whereas routine intervention appears unjustified given the lack of long‐term benefit and increased complication risk.

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