EL INFARTO AGUDO DE MIOCARDIO EN ANCIANOS: CARACTERÍSTICAS CLÍNICAS, TRATAMIENTO Y PRONÓSTICO | ACUTE MYOCARDIAL INFARCTION IN THE ELDERLY: CLINICAL CHARACTERISTICS, TREATMENT AND PROGNOSIS
Authors: Solís Marquínez, M.N
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Ischemic heart disease is the leading cause of death and disability in the developed world. According to population aging, individuals over 65 years of age now reach 20% of the total population and are expected to continue increasing in the coming decades. In recent years, the treatment of acute coronary syndrome has been implemented with a significant improvement in the prognosis of these patients, however, the quality and quantity of scientific evidence of treatment in the elderly is limited, due to the limited inclusion of patients in this age group in clinical trials. In addition, although there are studies in the elderly that show a greater survival with an intensive than conservative management, without showing significant differences in terms of bleeding complications, it is common to see a lower indication of these therapies due to an increased perceived risk of adverse effects. In order to avoid this subjectivity of the perceived risk and the correct classification of elderly patients in an intervention group or not, we must use the bleeding and ischemic risk scales, but also those of physical dependence, instrumental capacity, comorbidity, cognitive impairment, fragility and one’s own life expectancy at the time of diagnosis of acute coronary syndrome. On the other hand, the patient’s medication must always be reviewed jointly, relying on the STOPP-START criteria, as well as an adequate adjustment of the dose of the different active ingredients. Thus, in the majority of elderly patients with acute myocardial infarction, an early invasive strategy with coronary angiography and revascularization should be considered if necessary, in addition to antiplatelet treatment adapted to the characteristics of the patient, given the favorable risk-benefit relationship in terms of prognosis and complications inherent in it. For these reasons, future research should be directed to a greater inclusion of elderly patients in clinical studies and trials, given the progressive increase in this population group, the higher life expectancy and the high incidence of cardiovascular pathology together with its high mortality.