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Elderly Patients with ST-Segment Elevation Myocardial Infarction: A Patient-Centered Approach
Benoit Lattuca1,2, Mathieu Kerneis1, Michel Zeitouni1
1Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166, Institut de Cardiologie, Pitié-Salpêtrière Hospital (AP-HP), Paris, France.
Drugs & Aging
|April 7, 2019
Summary
Elderly patients with acute coronary syndrome (ACS) face high risks but lack trial data. A patient-centered approach balancing frailty and risks is crucial for optimal treatment decisions in older adults.
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Research
Background:
- Elderly patients (≥75 years) are a growing segment of the acute coronary syndrome (ACS) population.
- This demographic faces elevated risks of bleeding and ischemic events.
- Limited clinical trial data exists specifically for elderly ACS patients.
Purpose of the Study:
- To review evidence on optimal reperfusion and antithrombotic strategies for elderly patients with ST-segment elevation myocardial infarction (STEMI).
- To emphasize a patient-centered approach for therapeutic decision-making in very old patients.
Main Methods:
- Review of existing literature and clinical trial data concerning ACS and STEMI in the elderly.
- Analysis of treatment disparities and risk-benefit profiles in older versus younger patients.
- Examination of European clinical practice guidelines for STEMI management.
Main Results:
- Elderly patients are undertreated with invasive strategies and potent antithrombotics despite similar STEMI benefits.
- Guidelines suggest similar STEMI treatment regardless of age, but individual assessment is key.
- Therapeutic decisions require evaluating patient frailty and the bleeding-ischemic risk balance.
Conclusions:
- A personalized approach is necessary for managing STEMI in elderly patients.
- Balancing frailty, bleeding risk, and ischemic risk optimizes treatment.
- Further research dedicated to the elderly ACS population is warranted.
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