Elderly Patients with Non-ST-Elevation Acute Coronary Syndrome: A Proposal to Adapt Decision Making

Abstract

The guidelines recommend invasive treatment (coronary angiography) in elderly patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) with a moderate and high risk of re-infarction or death. The invasive approach has been found to be more effective in older and higher risk patients. The aim of this study was twofold: first, to determine whether the recommendations of current guidelines are followed for elderly patients with NSTE-ACS in our hospital; and second, to reach agreement among professionals responsible for the care of these patients (cardiologists, geriatricians, internists, specialists in emergency and critical care) on criteria that could enable the correct identification of the limitations of invasive management.Consistent with other studies and records in Spain and in neighbouring countries we found a tendency to deprive many patients of invasive treatment due solely to their age, with no underlying functional or cognitive factors or associated disorders that warranted it; hence the importance of developing multidisciplinary consensus criteria for the adequacy of invasive treatment in elderly patients with NSTE-ACS. The consensus criteria expressed in this manuscript could significantly aid decision-making in these patients and serve as a communication tool between the different specialists involved in their care. The usefulness of these criteria should be tested in future studies to assess whether their application helps to reduce the variability in clinical practice and improve clinical outcomes in the elderly population, especially in very elderly individuals.

Aimco Criteria (Adequacy of Invasive Management of Acute Coronary Syndrome in Older Patients): A Proposal to Adapt Decision Making

“…Recommendations based on randomized trials and observational studies that have found strong evidence that invasive treatment is more beneficial in elderly patients with NSTE-ACS than younger subjects, even considering the increased risk of bleeding in the elderly. Nonetheless, our data (3) and in other studies of neighbouring countries (4,5) show a tendency to perform invasive treatment of NSTE-ACS in patients with a lower risk and a younger age, depriving many patients of invasive treatment solely because of their age without any associated functional or cognitive disorders to warrant this.…”