Key result
Invasive management in octogenarians with ACS shows no significant 30-day mortality benefit over conservative care.
Why the study?
Octogenarians with ACS represent a high-risk group with comorbidities, frailty, and atypical clinical presentations, and there is limited evidence to guide the choice between conservative and invasive management strategies.
Does an invasive management strategy improve short-term clinical outcomes compared to conservative management in octogenarian patients with acute coronary syndrome?
Observational (n=197)
Yes
Does an invasive management strategy improve short-term clinical outcomes compared to conservative management in octogenarian patients with acute coronary syndrome?
In octogenarians with ACS, frailty and delirium frequently drive conservative management, though an invasive approach in selected patients appears safe without increasing major bleeding or short-term mortality.
Background Octogenarians (≥80 years) with Acute Coronary Syndrome (ACS) represent a high-risk group due to comorbidities, frailty, and atypical clinical presentations, which pose significant management challenges. There is limited evidence to guide optimal management, especially regarding the choice between conservative and invasive strategies. This study examines the clinical characteristics, treatment approaches, and short-term outcomes in this population. Methods In this multi-center observational study, 197 octogenarian ACS patients were enrolled between January 2022 and August 2024. Patients were categorized into conservative (57.4%) and invasive (42.6%) management groups. Demographics, comorbidities, clinical presentation, and geriatric assessments (Fried Frailty Scale, CAM, GDS) were collected. Outcomes assessed included in-hospital and 30-day mortality, reinfarction, bleeding (BARC ≥3), and target vessel revascularization (TVR). Results The cohort was predominantly NSTE-ACS (88.3%) with high frailty (53.8%). Selection bias was notable: the conservative group had more Peripheral Vascular Disease (38.9% vs. 19.0%, p=0.003) and delirium (42.5% vs. 26.2%, p=0.02), while the invasive group had higher GRACE scores (p=0.039) and BMI (p=0.028). In-hospital (5.9% vs. 7.9%) and 30-day mortality (9.6% vs. 15.9%) were lower in the invasive group, though these differences were not statistically significant. The invasive group had a higher TVR rate (13.1% vs. 0.0%, p<0.001) and a trend toward lower reinfarction (3.5% vs. 10.6%, p=0.12). Major bleeding rates were similar (13.1% vs. 9.7%, p=0.61). Conclusion Geriatric syndromes have a substantial impact on ACS management in octogenarians. Frailty and delirium are associated with a preference for conservative care. In appropriately selected patients, invasive treatment appears safe and may reduce recurrent events without increasing short-term risk. Comprehensive geriatric assessment is essential for individualized treatment planning.
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Mahmoud et al. (2026) conducted an observational in Acute Coronary Syndrome (ACS) (n=197). Invasive management strategy vs. Conservative management strategy was evaluated on 30-day mortality. Invasive management in octogenarians with ACS had non-significantly lower 30-day mortality (9.6% vs 15.9%) and similar major bleeding (13.1% vs 9.7%, p=0.61) vs conservative care.
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