[Coronary syndromes in the elderly].
Acute coronary syndromes (ACS) are frequent in the elderly and carry a poor prognosis. Severe coronary artery disease, frequent comorbidity, late diagnosis, and treatments themselves are responsible for high morbidity and mortality rates. Reluctance to treat elderly patients with new mechanical or chemical revascularization techniques is due to the higher risk profile. ACS may or may not be accompanied by ST elevation: STEMI corresponds to acute myocardial infarction before myocardial necrosis, while non STEMI corresponds to unstable angina and subendocardial necrosis. Despite the high incidence of STEMI in the elderly, older patients have been excluded from large randomized trials. Chemical and mechanical reperfusion are the two recommended treatments for patients hospitalized before the 6th hour. Intravenous thrombolysis is the most common strategy: it offers a 26% reduction in mortality compared to conventional treatment, but carries a higher risk of brain hemorrhage than in younger patients. In high-throughput centers with experienced cardiologists, primary angioplasty seems to be the optimal strategy, with fewer deaths and recurrent ischemia. Two approaches are possible for NST-ACS: conservative or interventional. The latter includes medical treatment, early coronarography and revascularization by angioplasty or surgery. This strategy, combined with aspirin, clopidogrel, and glycoprotein II B/IIIa receptor inhibitors, offers a larger absolute reduction in the 30-day major adverse clinical event rate than conservative management. Dedicated randomized trials are needed to provide a more thorough picture of ACS management in the elderly.
Bounhoure
Jean-Paul
JP
Service de cardiologie, CHU Toulouse-Rangueil, 2, avenue J. Poulhes, Toulouse 31403.
Carrié
Didier
D
Puel
Jacques
J
D000077284:Abciximab; D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D000077144:Clopidogrel; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy; D009204:Myocardial Revascularization; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013577:Syndrome; D015912:Thrombolytic Therapy; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077144:Clopidogrel; D013988:Ticlopidine; D000077284:Abciximab