Key result
Personalized NSTEACS management in octogenarians weighs comorbidity futility against revascularization benefits in frail patients.
Why the study?
Routine invasive management of NSTEACS has established benefit in the general population, but evidence-based recommendations in octogenarians remain scarce despite their growing numbers.
Does an invasive management strategy improve outcomes in octogenarians with NSTEACS?
Does an invasive management strategy improve outcomes in octogenarians with NSTEACS?
Decision-making for invasive management of NSTEACS in octogenarians requires a personalized approach incorporating geriatric factors like frailty and comorbidities.
Supports frailty-informed decisions for NSTEACS in octogenarians; leaves open need for dedicated RCTs.
The rate of octogenarians among patients with non-ST segment elevation acute coronary syndrome (NSTEACS) will continue to increase in the coming years due to population aging. Routine invasive management of NSTEACS has shown long-term benefit in general population but evidence-based recommendations in this subset of patients remain scarce. The decision-making process in elderly patients should take into account several geriatric factors including frailty, comorbidities, dependency, cognitive impairment, malnutrition, and polymedication. Chronological age is a poor marker of the biological situation in octogenarians and heterogeneity is common. Recent studies support an invasive strategy in most octogenarians. However, observational data suggest that significant comorbidities seem to be related to futility of an invasive approach whereas the risk-benefit balance in frail patients might favor revascularization. Further studies are needed to define a tailored approach in each octogenarian with NSTEACS through a better assessment and quantification of frailty, comorbidities and ischemic risk.
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Martínez-Solano et al. (2021) conducted a review in non-ST segment elevation acute coronary syndrome (NSTEACS). Invasive management strategy was evaluated. A personalized approach to invasive management of NSTEACS in octogenarians is needed, as significant comorbidities may render it futile while frail patients might still benefit from revascularization.
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