Management strategy of non-ST segment elevation acute coronary syndromes in octogenarians: a call for a personalized...

The rate of octogenarians among patients with non-ST segment elevation acute coronary syndrome (NSTEACS) will continue to increase in the coming years due to population aging. Routine invasive management of NSTEACS has shown long-term benefit in general population but evidence-based recommendations in this subset of patients remain scarce. The decision-making process in elderly patients should take into account several geriatric factors including frailty, comorbidities, dependency, cognitive impairment, malnutrition, and polymedication. Chronological age is a poor marker of the biological situation in octogenarians and heterogeneity is common. Recent studies support an invasive strategy in most octogenarians. However, observational data suggest that significant comorbidities seem to be related to futility of an invasive approach whereas the risk-benefit balance in frail patients might favor revascularization. Further studies are needed to define a tailored approach in each octogenarian with NSTEACS through a better assessment and quantification of frailty, comorbidities and ischemic risk.