title: Update: acute coronary syndromes (VI): treatment of acute coronary syndromes in the elderly and in patients with comorbidities.
abstract: Acute coronary syndromes have a wide spectrum of clinical presentations and risk of adverse outcomes. A distinction should be made between treatable (extent of ischemia, severity of coronary disease and acute hemodynamic deterioration) and untreatable risk (advanced age, prior myocardial damage, chronic kidney dysfunction, other comorbidities). Most of the patients with "untreatable" risk have been excluded from the "guideline-generating" clinical trials. In recent years, despite the paucity of specific randomized trials, major advances have been completed in the management of elderly patients and patients with comorbidities: from therapeutic nihilism to careful titration of antithrombotic agents, a shift toward the radial approach to percutaneous coronary interventions, and also to less-invasive cardiac surgery. Further advances should be expected from the development of drug regimens suitable for use in the elderly and in patients with renal dysfunction, from a systematic multidisciplinary approach to the management of patents with diabetes mellitus and anemia, and from the courage to undertake randomized trials involving these high-risk populations.
authors: Divisione di Cardiologia, Ospedale Manzoni, Lecco, Italy. Electronic address: s.savonitto@ospedale.lecco.it.
authors: Stefano
authors: S
authors: Savonitto
authors: Cardiologia Prima-Emodinamica, Ospedale Niguarda Ca' Granda, Milano, Italy.
authors: Nuccia
authors: N
authors: Morici
authors: Cure Intensive Coronariche, IRCCS Policlinico S. Matteo, Pavia, Italy.
authors: Stefano
authors: S
authors: De Servi
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D000740:Anemia / Q000150:complications; D048909:Diabetes Complications / Q000628:therapy; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D062645:Percutaneous Coronary Intervention; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012770:Shock, Cardiogenic / Q000150:complications / Q000175:diagnosis / Q000628:therapy
chemical_list: D005343:Fibrinolytic Agents
keywords: Anemia; Diabetes mellitus; Infarto de miocardio; Kidney; Myocardial infarction; Riñón