Non-st–elevation acute coronary syndrome in the elderly: treatment strategies and 30-day outcome

Outcomes of invasive treatment in very elderly Polish patients with non-ST-segment-elevation myocardial infarction from 2003–2009 (from the PL-ACS registry)

“…Registry studies also show the superiority of invasive treatments over conservative treatment in elderly NSTE-ACS patients [22,23]. In a 2002 Italian registry, the patients ≥ 75 years of age received treatment consistent with the guidelines less frequently; in the multifactorial analysis, conservative treatment significantly worsened the 30-days prognosis [22]. The analysis of the GRACE (The Global Registry of Acute Coronary Syndromes) registry clearly shows that the patients ≥ 80 years of age, who made up 16% of the population, received treatment consistent with the guidelines less frequently.…”

“…To sum up randomized trials, it seems that the subgroup analyses, despite their limitations, demonstrate the benefits of invasive treatment in elderly patients with NSTE-ACS, which is consistent with the results of our analysis. Registry studies also show the superiority of invasive treatments over conservative treatment in elderly NSTE-ACS patients [22,23]. In a 2002 Italian registry, the patients ≥ 75 years of age received treatment consistent with the guidelines less frequently; in the multifactorial analysis, conservative treatment significantly worsened the 30-days prognosis [22].…”

High-risk Acute Coronary Syndrome Patients with Non-ST-Elevation Myocardial Infarction: Definition and Treatment

“…Nevertheless, troponin-positive patients often did not receive beneficial strategies promptly in The Registry of Acute Coronary Syndromes (TRACS) study [12], and received arteriography less frequently than a conservative strategy in another study (59% vs. 71%; p<0.01) [13].…”

“…These could include the type of hospital or resources available within the hospital [13]. For example, a study of 1,581 patients enrolled in the Registro Osservazionale Angina Instabile-2 (ROSAI-2) registry in Italy showed that an aggressive strategy of coronary arteriography within 4 days of admission followed by revascularization where feasible was adopted more frequently in patients admitted to hospitals with catheterization facilities, compared with patients admitted to hospitals without such facilities (50% vs. 25%; p<0.001) [13].…”

Medium- to long-term outcomes in percutaneous coronary intervention in the very elderly population

“…Coronary artery disease remains the leading cause of morbidity and mortality in this population representing a high burden to the healthcare system [2]. With the improving safety and outcomes of percutaneous coronary intervention (PCI), this is an attractive revascularisation option in very elderly patients for both acute and stable coronary syndromes [3]. PCI in this group of patients is adversely influenced by the presence of multiple comorbidities, reduced physiological adaptation to stress and complex diseased coronary anatomy, thus, the outcomes in these patients, both peri-procedural and longer-term, are less predictable than in younger patients and are they are often excluded from clinical trials [4][5][6][7][8].…”