Management of ACS in the Elderly

by Ramesh Daggubati, MD

With baby boomers living longer, a day does not pass without a physician wondering how to manage acute coronary syndrome in the elderly.  Randomized controlled trials are lacking in the elderly. Patel K et al in an online publication in the American Journal of Cardiology evaluated data from 2 multi center registries of acute coronary syndromes and concluded that invasive management in the elderly resulted in poor outcomes measured by a short health form survey (SF-12).

Limitations of this publication are that these registries are not powered nor designed to evaluate outcomes of invasive vs ischemia guided management in the elderly. Moreover there were only 120 patients of age >85 in whom the physical component was significantly lower after one year older. ACC and ESC guidelines recommend invasive strategy based on risk criteria for ischemic complications.  At C3 this June, one can learn how to apply the guidelines in the elderly with acute coronary syndromes and to use frailty index to predict the outcomes of invasive therapies.

Patel KK, Arnold SV, Jones PG, Spertus JA et al. “Relation of Age and Health-related Quality of Life to Invasive Versus Ischemia-guided Management of Patients with Non-ST Elevation Myocardial Infarction”. Am J Cardiol. 2018; Epub ahead of print.

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