Management of acute coronary syndromes in older adults
Nuccia Morici1,2, Stefano De Servi3, Leonardo De Luca4
1Unità di Cure Intensive Cardiologiche, and De Gasperis Cardio-Center, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy.
European Heart Journal
|August 4, 2021
Summary
Older adults with acute coronary syndromes (ACS) benefit from an invasive approach over conservative management. Aggressive antithrombotic therapy increases bleeding risk without improving mortality in this population.
Area of Science:
- Cardiology
- Geriatric Medicine
- Clinical Research
Background:
- Older adults are underrepresented in acute coronary syndrome (ACS) clinical trials.
- This demographic is complex, heterogeneous, and high-risk, requiring a multidimensional approach.
- Recent trials offer new insights into managing ACS in older individuals.
Purpose of the Study:
- To review evidence-based interventional and pharmacological strategies for older adults with ACS.
- To discuss guideline-directed management tailored for this population.
- To highlight the importance of a holistic, geriatric-focused approach.
Main Methods:
- Systematic review of recent clinical trials and guideline-directed management.
- Analysis of benefit-risk ratios for invasive versus conservative strategies.
- Evaluation of antithrombotic therapy efficacy and safety in older ACS patients.
Main Results:
- An invasive strategy shows a favorable benefit-risk profile compared to conservative management for ACS in older adults.
- Intensified antithrombotic therapy increases bleeding risk without reducing mortality.
- Clinical complexity and comorbidities necessitate individualized treatment plans.
Conclusions:
- An invasive approach is generally preferred for older adults with ACS, considering their complexity.
- Current antithrombotic strategies require careful risk-benefit assessment to avoid excess bleeding.
- Integrating geriatric assessments is crucial for optimizing treatment and addressing biological vulnerability.
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