Importance of increasing age on the presentation and outcome of acute coronary syndromes in elderly patients

Pathological ankle–brachial index is equivalent of advanced age in acute coronary syndromes

“…The present subanalysis of the PAMISCA study demonstrates that pathological ABI confers similar prognosis than advanced age in the first year after an ACS, and the joint presence of these two conditions leads to the highest mortality rate. Age > 75 years and pathological ABI were highly prevalent in this population what agrees with previous registries performed in the setting of ACS or coronary heart disease [1,2,[7][8][9][14][15][16]. The Global Registry of Acute Coronary Events (GRACE) registry evidenced that 27% of patients with ACS had age between 70 and 80 years and 16% were > 80 years [9].…”

“…First, a relevant patient lost between the inclusion and the beginning of the prospective phase reveals difficulties in performing prospective and multicentre studies without specific interventions; nevertheless, previous publications were focused on the incidence of mortality and major events during hospital stay in whole cohort [16] and in the subgroup of hypertensive patients [17]. Second, the incidence of mortality and cardiovascular events through the follow-up was lower than other ACS registries [1][2][3][4][5][6][7][8][9], and this could explain why no variable obtained protective effects in the multivariate analysis; even so, the highly statistical significance of the results might endorse the clinical relevancy of our results. Third, only patients who survived during hospital stay were included in the prospective phase, and therefore, a significant percentage of high-risk patients could not be analysed because they died during hospital stay, and it could explain the relatively low mortality rate of the total cohort.…”

“…Clinical registries and randomized trials agree in the fact that age is one of the leading factors of worst prognosis in the setting of acute coronary syndromes (ACS) [1][2][3][4][5]. In fact, elderly patients are a collective of high-risk patients with higher mortality and event rates but are usually treated less aggressively in terms of lower reperfusion, catheterization or treatment prescription [6][7][8][9].…”

Age‐Dependent Differences in Presentation, Risk Factor Profile, and Outcome of Suspected Acute Coronary Syndrome

“…9,[14][15][16][17][18][19] This is despite a growing evidence base in favor of more-aggressive intervention in all patients, including older people. [20][21][22][23][24] Even simple, established therapies such as aspirin and betablockers are less likely to be used in older people. [14][15][16][17][18] The widespread application of such strategies in older people should be a priority for attending clinicians, although further research may be required to prove that these discrepancies are unrelated to confounding factors.…”

Optimal Revascularization Strategies for ST‐Segment Elevation Myocardial Infarction in the Elderly Patient

“…Extensive coronary artery disease is frequently found at the time of first presentation. They receive coronary angiography and acute reperfusion less often; only 21.7% of patients aged 80 to 84 years with STEMI receive timely revascularization 2–11 …”