[Unstable angina in the elderly].
Unstable angina and acute coronary syndromes without persistent ST-segment elevation are frequent and their prognosis is poor in the elderly. Indeed, age is the most powerful predictor of in-hospital mortality in this setting. The clinical benefit of interventional strategies, as demonstrated by FRISC II and TACTICS TIMI 18 studies, seems to be most important in this age subset. PURSUIT trial demonstrates that the efficacy of eptifibatide, a IIb/IIIa platelet receptor inhibitor, increases in elderly patients who simultaneously undergo revascularization interventions. Individual application of such treatment strategies may be difficult. Potential triggering factors of unstable angina and comorbidities have to be taken into account, and the overall management should be highly individualized in elderly patients. The aim remains to achieve appropriate myocardial revascularization, as often as possible by focusing coronary angioplasty on the culprit vessel. Coronary surgery generally should be reserved for coronary lesions which are not suitable for percutaneous revascularization. Clinical improvement is maximal in patients with severe initial presentation.
Himbert
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Service de cardiologie, groupe hospitalier Bichat-Claude Bernard, 46, rue Henri Huchard, 75018 Paris, France. dominique.himbert@bch.ap-hop-paris.fr
D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable / Q000628:therapy; D003327:Coronary Disease / Q000628:therapy; D006801:Humans; D011379:Prognosis; D013577:Syndrome