Acute Coronary Syndromes in the Octogenarians

Dear Colleagues,

Acute Coronary Syndromes (ACS) in Octogenarians are a clinical challenge. The evidence of pharmacological treatments and of invasive approach is less robust than in patients younger than 80 years. Octogenarians have a high incidence of ACS. Moreover, globally, the population aged 80 and over is growing faster than all other age groups. However, octogenarians are seldom included in clinical trails. Moreover, when included, they are usually a highly-selected sample that does not represent elderly patients, with frequent comorbidity and frailty, seen in every-day practice. Octogenarians often sustain a poor outcome after an ACS due to several reasons including atypical presentation and delay in recognition, under treatment and ageism, and the presence of other conditions. Octogenarians commonly do not receive optimal guideline-directed ACS treatment. They have a high baseline risk both of ischemic complications and bleeding events, and also fare worse even with optimal treatment and are more vulnerable to medical errors and drug side-effect. Also, the elderly frequently have more complex and severe coronary disease and a higher rate of treatment complications. Appropriate management of these patients is only possible with a correct comprehensive geriatric assessment elderly that should include the evaluation of frailty, comorbidity, quality of life, cognitive impairment, goals of care, and individual preferences. As the population continues to age, physicians will be confronted with an increasing number of octogenarian with ACS, it is imperative to prepare to assess the overall health status of these patients, and to predict their life expectancy and the tolerance of treatments.

Dr. Manuel Martínez-Sellés

Guest Editor

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