Challenges and Controversies in the Management of ACS in Elderly Patients

Waleed T. Kayani, Mahin R. Khan, Matthew R. Deshotels, Hani Jneid

Research output: Contribution to journalReview articlepeer-review


Purpose of Review: Elderly patients presenting with acute coronary syndrome (ACS) represent a challenging patient population. A high index of suspicion is needed for their diagnosis, as they are less likely to present with typical anginal symptoms compared to their younger counterparts. Recent Findings: Disrupted coronary plaques with superimposed thrombosis are the predominant pathophysiology of ACS; however, an increased proportion of calcified nodules is encountered in elderly patients. Emergent reperfusion and revascularization remain the mainstay treatment for ST-elevation myocardial infarction or cardiogenic shock. In elderly patients with NSTE-ACS, a routine invasive strategy is generally superior to an ischemia-guided strategy, and the safety of an early invasive strategy has also been recently demonstrated. Summary: When treating elderly ACS patients with antiplatelet and antithrombotic therapies, close attention to co-morbidities, frailty and the balance of ischemia-bleeding risk should be undertaken, and medication doses should be carefully adjusted. Overall, elderly patients with ACS remain undertreated with evidence-based therapies, experience worse outcomes, and represent an opportunity for enhancing and mitigating healthcare disparities.

Original languageEnglish (US)
Article number51
JournalCurrent Cardiology Reports
Issue number7
StatePublished - Jul 1 2020
Externally publishedYes


  • Acute coronary syndrome
  • Antiplatelet therapy
  • Elderly
  • Octogenarians
  • Older adults

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Challenges and Controversies in the Management of ACS in Elderly Patients'. Together they form a unique fingerprint.

Cite this