Update on pharmacological treatment of acute coronary syndrome without persistent ST segment elevation myocardial
1Department of Pharmacology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
Insights
Elderly patients with acute coronary syndrome (ACS) benefit from tailored pharmacological treatments, including dual antiplatelet therapy with P2Y12 inhibitors. Invasive strategies may be most useful, emphasizing individualized care based on patient factors.
Area of Science:
- Cardiology
- Geriatrics
- Pharmacology
Background:
- Cardiovascular disease prevalence increases with age due to vascular elasticity changes, coagulation system alterations, and endothelial dysfunction.
- Mortality risk significantly rises with age, with a 50% increase per decade after 65.
- Acute coronary syndrome (ACS) management in the elderly requires specific considerations to prevent ischemia, myocardial damage, and complications.
Purpose of the Study:
- To discuss pharmacological treatment strategies for ACS without persistent ST-segment elevation myocardial infarction in elderly patients.
- To highlight the importance of individualized treatment approaches in older adults with ACS.
- To review the role of antiplatelet therapies, particularly P2Y12 inhibitors, in elderly ACS management.
Main Methods:
- Review of existing meta-analyses and clinical guidelines.
- Discussion of pharmacological agents, focusing on dual antiplatelet therapy and P2Y12 inhibitors.
- Consideration of patient-specific factors such as age, body weight, renal function, comorbidities, and frailty.
Main Results:
- Invasive revascularization therapy may be most beneficial for older patients with ACS.
- Dual antiplatelet therapy is the current standard of care post-ACS.
- Potent P2Y12 inhibitors are crucial for treating and preventing arterial thrombosis in elderly ACS patients.
Conclusions:
- Pharmacological treatment for elderly ACS patients should be tailored, considering individual risk-benefit profiles and life expectancy.
- P2Y12 inhibitors will remain vital in the future pharmacological treatment of elderly ACS patients.
- Individualized antithrombotic treatment strategies are essential for optimizing outcomes in older adults with ACS.
Abstract:
The increase in cardiovascular disease prevalence with ageing has been attributed to several age-related changes such as changes in the vascular wall elasticity, the coagulation and haemostatic system and endothelial dysfunction, among other causes. There is a 50% increased mortality risk per 10-year increase in age starting at 65 years old. Here, we aimed to discuss pharmacological treatment in acute coronary syndrome (ACS) without persistent ST segment elevation myocardial infarction in the elderly. The main aim of ACS treatment in elderly people is at preventing ischemia, myocardial damage and complications. A meta-analysis suggests that invasive revascularization therapy is probably most useful in older patients. Dual antiplatelet therapy is currently the standard of care post-ACS. Platelet P2Y12 inhibitors are among the most commonly used medications worldwide, due to their established benefits in the treatment and prevention of arterial thrombosis. The main recommendation is to tailor antithrombotic treatment, considering body weight, renal function (Class I, level C) and careful evaluation of life expectancy, comorbidities, risk/benefit profile, quality of life and frailty when invasive strategies are considered (Class IIa, level A) on top of the different recommendations given for a general non ST elevation ACS population. It is obvious that potent P2Y12 inhibitors will continue to play an important role in pharmacological treatment for elderly ACS patients in the future.
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