IMR Press / RCM / Volume 22 / Issue 4 / DOI: 10.31083/j.rcm2204129
Open Access Review
Management strategy of non-ST segment elevation acute coronary syndromes in octogenarians: a call for a personalized approach
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1 Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria (IiSGM), CIBERCV, 28007 Madrid, Spain
2 Facultad de Medicina, Universidad Complutense, 28040 Madrid, Spain
3 Facultad de Ciencias Biomédicas, Universidad Europea, 28670 Madrid, Spain
*Correspondence: (Manuel Martínez-Sellés)
Academic Editor: Leonardo De Luca
Rev. Cardiovasc. Med. 2021, 22(4), 1205–1214;
Submitted: 28 July 2021 | Revised: 10 September 2021 | Accepted: 15 September 2021 | Published: 22 December 2021
(This article belongs to the Special Issue Acute Coronary Syndromes in the Octogenarians)
Copyright: © 2021 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license (

The rate of octogenarians among patients with non-ST segment elevation acute coronary syndrome (NSTEACS) will continue to increase in the coming years due to population aging. Routine invasive management of NSTEACS has shown long-term benefit in general population but evidence-based recommendations in this subset of patients remain scarce. The decision-making process in elderly patients should take into account several geriatric factors including frailty, comorbidities, dependency, cognitive impairment, malnutrition, and polymedication. Chronological age is a poor marker of the biological situation in octogenarians and heterogeneity is common. Recent studies support an invasive strategy in most octogenarians. However, observational data suggest that significant comorbidities seem to be related to futility of an invasive approach whereas the risk-benefit balance in frail patients might favor revascularization. Further studies are needed to define a tailored approach in each octogenarian with NSTEACS through a better assessment and quantification of frailty, comorbidities and ischemic risk.

Non-ST elevation acute coronary syndrome
Fig. 1.
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