Update on pharmacological treatment of acute coronary syndrome without persistent ST segment elevation myocardial infarction in the elderly

The increase in cardiovascular disease prevalence with ageing has been attributed to several age-related changes such as changes in the vascular wall elasticity, the coagulation and haemostatic system and endothelial dysfunction, among other causes. There is a 50% increased mortality risk per 10-year increase in age starting at 65 years old. Here, we aimed to discuss pharmacological treatment in acute coronary syndrome (ACS) without persistent ST segment elevation myocardial infarction in the elderly. The main aim of the ACS treatment in elderly people is at preventing ischemia, myocardial damage and complications. A meta-analysis suggests that invasive revascularization therapy is probably most useful in older patients. Dual antiplatelet therapy is currently the standard of care post-ACS. Platelet P2Y12 inhibitors are among the most commonly used medications worldwide, due to their established benefits in the treatment and prevention of arterial thrombosis. The main recommendation is to tailor antithrombotic treatment, considering body weight, renal function (Class I, level C) and careful evaluation of life expectancy, comorbidities, risk/benefit profile, quality of life and frailty when invasive strategies are considered (Class IIa, level A) on top of the different recommendations given for a general non ST elevation ACS population. It is obvious that potent P2Y12 inhibitors will continue to play an important role in pharmacological treatment for elderly ACS patients in the future.