Acute coronary syndrome in elderly: Current status and unresolved issues
Cardiovascular diseases impact at most the morbidity, mortality and life quality of the elderly. However this population is underrepresented in clinical trials, hence management of this sort of patients is a gap in evidence. Acute coronary syndrome (ACS) requires active treatment from the very first minutes from myocardial ischemia onset. The riskbenefit ratio of invasive approach in a very old is still foggy, as there is no consideration of the risks related to frailty and other individual specifics of a patient, as the comorbidities. In the article, randomized trials data is presented, as of registries, that included aimfully ACS patients 75 years and older. The specifics of intervention is pointed in, its efficacy, and complications of reperfusion therapy in ACS with ST elevation (STEMI) in the senile. In details, an issue considered on the tactics of ACS treatment in non-ST-elevation ACS (NSTEMI), as the rationale for earlier invasive tactics - coronary arteriography and, if indicated, percutaneous coronary intervention during 72 hours, or the conservative therapy at first, and coronary arteriography and revascularization only if ischemia recur; safety of the primary invasive approach; interventional approach by default or individualized approach and influence of such choice on 5-year cardiovascular mortality and myocardial infarction. Special attention is paid on a necessity of geriatric support of patients, presence and significance of the frailty and its influence on ACS treatment outcomes, life quality of the old after ACS, and organization of ACS registry of ≥80 y. o. persons from various regions of Russia.