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Published on: March 15, 2022

Elderly Patients with Acute Coronary Syndromes: Higher Risk and Greater Benefit from Antithrombotic and

Christopher P. Cannon1

  • 1Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA.

The American Journal of Geriatric Cardiology
|June 21, 2001
PubMed

Insights

Elderly patients with acute coronary syndromes face poorer outcomes. However, older adults with unstable angina and non-ST elevation myocardial infarction benefit more from advanced antithrombotic therapies and interventions.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Pharmacology

Background:

  • Elderly patients with acute coronary syndromes (ACS) exhibit worse outcomes compared to younger individuals.
  • Certain ACS therapies, like thrombolysis for ST elevation myocardial infarction, show diminished benefit in the elderly.

Purpose of the Study:

  • To evaluate the efficacy of newer antithrombotic therapies and interventional strategies in elderly patients with ACS.
  • To compare treatment benefits between elderly and younger patient cohorts in ACS.

Main Methods:

  • Analysis of data from clinical trials including the Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q-Wave Coronary Events (ESSENCE) and Thrombolysis in Myocardial Infarction (TIMI) IIB trials.
  • Comparison of low molecular weight heparin (enoxaparin) versus unfractionated heparin, glycoprotein IIb/IIIa inhibitors, and invasive versus conservative strategies.

Main Results:

  • Elderly patients (≥65 years) showed greater relative and absolute benefits from enoxaparin compared to unfractionated heparin.
  • Glycoprotein IIb/IIIa inhibitors provided greater absolute benefits in older patients.
  • Patients ≥65 years derived significantly more benefit from an invasive strategy than a conservative one in the FRagmin and Fast Revascularisation during InStability in Coronary Artery Disease (FRISC II) trial.

Conclusions:

  • Elderly patients with unstable angina and non-ST elevation myocardial infarction are at higher risk but gain substantial benefit from aggressive antithrombotic and interventional therapies.
  • Age-related differences in treatment response highlight the need for tailored ACS management strategies in older adults.

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