Age Considerations in the Invasive Management of Acute Coronary Syndromes

Overview

Journal US Cardiol

Date 2024 Nov 27

PMID 39600832

Authors

Mansi Oberoi

Nitesh Ainani

J Dawn Abbott

Mamas A Mamas

Poonam Velagapudi

Affiliations

Soon will be listed here.

Abstract

The elderly constitute a major proportion of patients admitted with acute coronary syndrome (ACS) in the US. Due to pre-existing comorbidities, frailty, and increased risk ofcomplications from medical and invasive therapies, management ofACS in the elderly population poses challenges. In patients with ST-elevation MI, urgent revascularization with primary percutaneous coronary intervention remains the standard of care irrespective of age. However, an early invasive approach in elderly patients with non-ST-elevation MI is based on individual evaluation of risks versus benefits. In this review, the authors discuss the unique characteristics of elderly patients presenting with ACS, specific geriatric conditions that need to be considered while making treatment decisions in these situations, and available evidence, current guidelines, and future directions for invasive management of elderly patients with ACS.

References

Fleg J, Forman D, Berra K, Bittner V, Blumenthal J, Chen M . Secondary prevention of atherosclerotic cardiovascular disease in older adults: a scientific statement from the American Heart Association. Circulation. 2013; 128(22):2422-46. PMC: 4171129. DOI: 10.1161/01.cir.0000436752.99896.22. View

Awad K, Mikhailidis D, Toth P, Jones S, Moriarty P, Lip G . Efficacy and Safety of Alternate-Day Versus Daily Dosing of Statins: a Systematic Review and Meta-Analysis. Cardiovasc Drugs Ther. 2017; 31(4):419-431. DOI: 10.1007/s10557-017-6743-0. View

Secemsky E, Butala N, Raja A, Khera R, Wang Y, Curtis J . Comparative Outcomes of Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction Among Medicare Beneficiaries With Multivessel Coronary Artery Disease: An National Cardiovascular Data Registry Research to Practice Project. Circ Cardiovasc Interv. 2021; 14(8):e010323. PMC: 8485756. DOI: 10.1161/CIRCINTERVENTIONS.120.010323. View

Oh E, Fong T, Hshieh T, Inouye S . Delirium in Older Persons: Advances in Diagnosis and Treatment. JAMA. 2017; 318(12):1161-1174. PMC: 5717753. DOI: 10.1001/jama.2017.12067. View

OGara P, Kushner F, Ascheim D, Casey Jr D, Chung M, de Lemos J . 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2012; 127(4):529-55. DOI: 10.1161/CIR.0b013e3182742c84. View

Wang T, McCoy L, Bhatt D, Rao S, Roe M, Resnic F . Multivessel vs culprit-only percutaneous coronary intervention among patients 65 years or older with acute myocardial infarction. Am Heart J. 2016; 172:9-18. DOI: 10.1016/j.ahj.2015.10.017. View

Alnasser S, Bagai A, Jolly S, Cantor W, Dehghani P, Rao S . Transradial approach for coronary angiography and intervention in the elderly: A meta-analysis of 777,841 patients. Int J Cardiol. 2016; 228:45-51. DOI: 10.1016/j.ijcard.2016.11.207. View

Shah P, Najafi A, Panza J, Cooper H . Outcomes and quality of life in patients>or=85 years of age with ST-elevation myocardial infarction. Am J Cardiol. 2009; 103(2):170-4. DOI: 10.1016/j.amjcard.2008.08.051. View

Bueno H, Betriu A, Heras M, Alonso J, Cequier A, Garcia E . Primary angioplasty vs. fibrinolysis in very old patients with acute myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) randomized trial and pooled analysis with previous studies. Eur Heart J. 2010; 32(1):51-60. PMC: 3013200. DOI: 10.1093/eurheartj/ehq375. View

10.

Bach R, Cannon C, Weintraub W, DiBattiste P, Demopoulos L, Anderson H . The effect of routine, early invasive management on outcome for elderly patients with non-ST-segment elevation acute coronary syndromes. Ann Intern Med. 2004; 141(3):186-95. DOI: 10.7326/0003-4819-141-3-200408030-00007. View

11.

Furnaz S, Karim M, Ashraf T, Ali S, Shahid I, Ali S . Performance of the TIMI risk score in predicting mortality after primary percutaneous coronary intervention in elderly women: Results from a developing country. PLoS One. 2019; 14(7):e0220289. PMC: 6657879. DOI: 10.1371/journal.pone.0220289. View

12.

Clegg A, Young J, Iliffe S, Rikkert M, Rockwood K . Frailty in elderly people. Lancet. 2013; 381(9868):752-62. PMC: 4098658. DOI: 10.1016/S0140-6736(12)62167-9. View

13.

Guerrero C, Ariza-Sole A, Formiga F, Martinez-Selles M, Vidan M, Aboal J . Applicability of the PRECISE-DAPT score in elderly patients with myocardial infarction. J Geriatr Cardiol. 2019; 15(12):713-717. PMC: 6330266. DOI: 10.11909/j.issn.1671-5411.2018.12.003. View

14.

Alexander K, Newby L, Armstrong P, Cannon C, Gibler W, Rich M . Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of.... Circulation. 2007; 115(19):2570-89. DOI: 10.1161/CIRCULATIONAHA.107.182616. View

15.

Husted S, James S, Becker R, Horrow J, Katus H, Storey R . Ticagrelor versus clopidogrel in elderly patients with acute coronary syndromes: a substudy from the prospective randomized PLATelet inhibition and patient Outcomes (PLATO) trial. Circ Cardiovasc Qual Outcomes. 2012; 5(5):680-8. DOI: 10.1161/CIRCOUTCOMES.111.964395. View

16.

Varenne O, Cook S, Sideris G, Kedev S, Cuisset T, Carrie D . Drug-eluting stents in elderly patients with coronary artery disease (SENIOR): a randomised single-blind trial. Lancet. 2017; 391(10115):41-50. DOI: 10.1016/S0140-6736(17)32713-7. View

17.

Ibanez B, James S, Agewall S, Antunes M, Bucciarelli-Ducci C, Bueno H . 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European.... Eur Heart J. 2017; 39(2):119-177. DOI: 10.1093/eurheartj/ehx393. View

18.

Capranzano P, Angiolillo D . Antithrombotic Management of Elderly Patients With Coronary Artery Disease. JACC Cardiovasc Interv. 2021; 14(7):723-738. DOI: 10.1016/j.jcin.2021.01.040. View

19.

Giallauria F, Di Lorenzo A, Venturini E, Pacileo M, DAndrea A, Garofalo U . Frailty in Acute and Chronic Coronary Syndrome Patients Entering Cardiac Rehabilitation. J Clin Med. 2021; 10(8). PMC: 8071180. DOI: 10.3390/jcm10081696. View

20.

Bromage D, Jones D, Rathod K, Grout C, Iqbal M, Lim P . Outcome of 1051 Octogenarian Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention: Observational Cohort From the London Heart Attack Group. J Am Heart Assoc. 2016; 5(6). PMC: 4937253. DOI: 10.1161/JAHA.115.003027. View