Elderly patients with acute coronary syndromes frequently present with atypical symptoms and have higher mortality, but benefit significantly from early invasive strategies and evidence-based pharmacotherapy.
Despite higher baseline risks and frailty, elderly patients with acute coronary syndromes benefit significantly from early invasive strategies and evidence-based pharmacotherapy, which should not be withheld based on age alone.
Abstract Cardiovascular pathology in the elderly is a topic of particular interest because it is themain cause of morbidity and mortality in this segment of the population, but also because in the last century the population over 60 years (this is the arbitrary limit from which a person is considered to be elderly) has doubled and is estimated to increase 2-3 times during the first century of this millennium. With the aging of the population, the number of associated diseases increases, but also the complexity of treatment for these diseases and the cost of hospitalization. Ischemic coronary artery disease has an increased incidence in the elderly population. Acute myocardial infarction (AMI) with ST segment elevation is manifested relatively frequently with atypical symptoms at onset - dyspnea, diaphoresis, nausea, confusion, epigastric pain, syncope. The influence of age on diagnosis and therapeutic management. There are no electrical changes in 40% of the elderly with acute myocardial infarction. Statistics show that 50% of patients addmited for AMI are elderly and 80% of acute myocardial infarction deaths occur in the elderly, due to both greater risk of post-treatment complications (eg left ventricular rupture after fibrinolysis) and general suboptimal treatment in the eldery, either due to age, comorbidities and atypical presentation delaying the diagnosis. Generally, outcomes of patients undergoing percutaneous coronary intervention are better compared to patients treated with fibrinolysis, the invasive strategy being thus preferred in these patients.
Pașc et al. (2019) conducted a review in Acute Coronary Syndromes. Elderly patients with acute coronary syndromes frequently present with atypical symptoms and have higher mortality, but benefit significantly from early invasive strategies and evidence-based pharmacotherapy.