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

Abstract

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.

Invasive Strategy in Octogenarians with Non-ST-Segment Elevation Acute Myocardial Infarction

“…Patients’ perspectives, values and opinions are key in the decision-making process and should be incorporated into the protocolized decision [ 101 ]. Some patients might prefer the option with the lowest risk for harm, even if the long-term benefit is lower [ 102 ].…”

Shared Decision-Making: The More the Patient Knows, the Better the Decision that Is Made

“…Well-designed decision aids that present patients with all contemporary therapeutic options may be useful adjuncts to practice in many complex medical situations [ 12 ]. The presentation of balanced options with a PDA might suggest that medical science has not fully determined what the best treatment option is [ 13 , 14 , 15 ], a recognition that can be upsetting to patients, who may seek a second opinion from a more confident, if less patient-oriented, medical professional.…”