Acute coronary syndromes in the elderly.
The elderly constitute an increasingly important sector of patients with acute coronary syndromes (ACS), although they have been under-represented in many therapeutic trials. Elderly patients with ACS usually have more complex co-morbidities and worse outcomes than their younger counterparts, and they are less likely to undergo revascularisation or to receive short- and long-term evidence-based medications. The most common ACS in the elderly is non-ST-segment elevation myocardial infarction (STEMI), which is associated with high mortality. For this reason, elderly patients with non-STEMI and unstable angina should be treated invasively early in the course of the episode. In elderly patients with STEMI, primary angioplasty seems to be more effective than fibrinolysis, and in patients aged >85 years a more conservative approach to fibrinolysis is also warranted because of the higher risk for cerebral haemorrhage. Therefore, angioplasty should be preferred when feasible, although more trials are needed before this strategy can definitely be documented as the preferred option. Drug-eluting stents afford greater benefit than bare metal stents in elderly patients and are more cost effective. After fibrinolysis, low-molecular-weight heparin appears to be superior to unfractionated heparin in elderly patients with STEMI but major bleeding and intracranial haemorrhages occur more frequently, especially in women aged >75 years. It is very important to understand that the elderly with ACS constitute a subgroup of atherosclerotic patients for whom decision making must be guided by the patients''physiological age' (determined by their physical condition and other co-morbidities) and not strictly by their 'chronological age'.
Kyriakides
Zenon S
ZS
2nd Department of Cardiology, Hellenic Red Cross Hospital, Athens, Greece. zskyr@otenet.gr
Kourouklis
Spyros
S
Kontaras
Konstantinos
K
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control / Q000601:surgery / Q000628:therapy*; D000368:Aged / Q000502:physiology*; D000787:Angina Pectoris / Q000150:complications; D015906:Angioplasty, Balloon, Coronary; D002317:Cardiovascular Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D054855:Drug-Eluting Stents; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D011379:Prognosis; D012770:Shock, Cardiogenic / Q000150:complications / Q000188:drug therapy; D015607:Stents
D002317:Cardiovascular Agents; D005343:Fibrinolytic Agents