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Acute Coronary Syndrome in the Older Adult Populations

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Cardiovascular Disease in the Elderly

Part of the book series: Contemporary Cardiology ((CONCARD))

Abstract

Coronary artery disease remains one of the major causes of mortality and morbidity in the older adult population. The aging process further increases the risk of adverse outcomes after acute coronary syndromes because coronary artery disease complexity is enhanced with advanced age by the presence of calcification, bifurcation lesions, and multivessel or left main involvement. Common geriatric syndromes like multimorbidity, polypharmacy, cognitive impairment, delirium, frailty, disability, and functional decline play a major role in the management and prognosis of acute coronary syndrome while simultaneously leading to worse geriatric impairment, including disability, during follow-up. Management of an acute coronary syndrome in older adults follows the same principles as of younger populations, but the utilization of guideline-recommended therapies is usually limited in older patients because of poor prognosis and increased risk of adverse events. Physicians should be aware of the available evidence regarding the safety and efficacy of pharmacological and interventional therapies in older patients for the best possible outcome. Rather than using a “one size fits all” approach, therapeutic interventions should be tailored at an individual level along with shared decision-making with the patient and their caregivers to achieve an overall improved quality of life as a precept to a holistic approach to cardiovascular care in older adults.

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References

  1. United Nations Global Issues: Ageing. https://www.un.org/en/global-issues/ageing. World Health organization https://www.who.int/news-room/fact-sheets/detail/ageing-and-health

  2. United States Census Bureau, The Older Population in the United States: 2019. https://www.census.gov/data/tables/2019/demo/age-and-sex/2019-older-population.html.

  3. Global Burden of Cardiovascular Diseases Collaboration. The burden of cardiovascular diseases among US states, 1990-2016. JAMA Cardiol. 2018;3(5):375–89. https://doi.org/10.1001/jamacardio.2018.0385.

    Article  Google Scholar 

  4. Cardiovascular Disease: A Costly Burden for America. https://www.heart.org/en/get-involved/advocate/federal-priorities/cardiovascular-disease-burden-report.

  5. Dunbar SB, Khavjou OA, Bakas T, Hunt G, Kirch RA, Leib AR, Morrison RS, Poehler DC, Roger VL, Whitsel LP, American Heart Association. Projected Costs of Informal Caregiving for Cardiovascular Disease: 2015 to 2035: A Policy Statement From the American Heart Association. Circulation. 2018;137:e558–77. https://doi.org/10.1161/CIR.0000000000000570.

    Article  Google Scholar 

  6. Rodríguez-Queraltó O, Guerrero C, Formiga F, Calvo E, Lorente V, Sánchez-Salado JC, Llaó I, Mateus G, Alegre O, Ariza-Solé A. Geriatric assessment and in-hospital economic cost of elderly patients with acute coronary syndromes. Heart Lung Circ. 2021;30(12):1863–9.

    Article  Google Scholar 

  7. The economic impact of acute coronary syndrome on length of stay: an analysis using the Healthcare Cost and Utilization Project (HCUP) databases. https://doi.org/10.3111/13696998.2014.885907.

  8. Simpson J, Javanbakht M, Vale L. Early invasive strategy in senior patients with non-ST-segment elevation myocardial infarction: is it cost-effective? A decision-analytic model and value of information analysis. BMJ Open. 2019;9:e030678. https://doi.org/10.1136/bmjopen-2019-030678.

    Article  Google Scholar 

  9. Forné C, Subirana I, Blanch J, et al. A cost-utility analysis of increasing percutaneous coronary intervention use in elderly patients with acute coronary syndromes in six European countries. Eur J Prev Cardiol. 2021;28(4):408–17. https://doi.org/10.1177/2047487320942644.

    Article  Google Scholar 

  10. Alexander KP, Newby LK, Cannon CP, et al. American Heart Association Council on Clinical Cardiology, & Society of Geriatric Cardiology. Acute coronary care in the elderly, part I: non-ST-segment-elevation acute coronary syndromes: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007;115(19):2549–69.

    Article  Google Scholar 

  11. Alexander KP, Newby LK, Armstrong PW, et al. Acute coronary care in the elderly, part II: ST-segment-elevation myocardial infarction: a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology: in collaboration with the Society of Geriatric Cardiology. Circulation. 2007;115(19):2570–89.

    Article  Google Scholar 

  12. Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61:e78–140.

    Article  Google Scholar 

  13. Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non–ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;64:e139–228.

    Article  Google Scholar 

  14. McClelland RL, Chung H, Detrano R, Post W, Kronmal RA. Distribution of coronary artery calcium by race, gender, and age: results from the multi-ethnic study of atherosclerosis (MESA). Circulation. 2006;113(1):30–7. https://doi.org/10.1161/CIRCULATIONAHA.105.580696.

    Article  Google Scholar 

  15. Batchelor WB, Anstrom KJ, Muhlbaier LH, Grosswald R, Weintraub WS, O’Neill WW, Peterson ED. Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: results in 7,472 octogenarians. National Cardiovascular Network Collaboration. J Am Coll Cardiol. 2000;36(3):723–30. https://doi.org/10.1016/s0735-1097(00)00777-4.).

    Article  CAS  Google Scholar 

  16. Feldman DN, Gade CL, Slotwiner AJ, et al. Comparison of outcomes of percutaneous coronary interventions in patients of three age groups (<60, 60 to 80, and >80 years) (from the New York state angioplasty registry). Am J Cardiol. 2006;98(10):1334–9.

    Article  Google Scholar 

  17. North BJ, Sinclair DA. The intersection between aging and cardiovascular disease. Circ Res. 2012;110(8):1097–108. https://doi.org/10.1161/CIRCRESAHA.111.246876.

    Article  CAS  Google Scholar 

  18. Damluji A, Ramireddy A, Forman DE. Management and care of older cardiac patients https://doi.org/10.1016/b978-0-12-809657-4.64094-2.

  19. O’Neill DE, Forman DE. Cardiovascular care of older adults. BMJ (Clinical research ed). 2021;374:n1593. https://doi.org/10.1136/bmj.n1593.

    Article  Google Scholar 

  20. Lee BH. Oh, aging and arterial stiffness. Circ J. 2010;74:2257–62.

    Article  Google Scholar 

  21. Scioli MG, Bielli A, Arcuri G, Ferlosio A, Orlandi A. Ageing and microvasculature. Vasc Cell. 2014;6:19Y.

    Article  Google Scholar 

  22. Safar M. Arterial aging—hemodynamic changes and therapeutic options. Nat Rev Cardiol. 2010;7:442–9. https://doi.org/10.1038/nrcardio.2010.96.

    Article  Google Scholar 

  23. American Heart Association, Inc. AHA Statistical Update. Heart Disease and stroke statistics—2021 Update: A report from the American Heart Association. Circulation. 2021;143:e254–743. https://doi.org/10.1161/CIR.0000000000000950e254.

    Article  Google Scholar 

  24. Myerson M, Coady S, Taylor H, Rosamond WD, Goff DC Jr, ARIC Investigators. Declining severity of myocardial infarction from 1987 to 2002: the atherosclerosis risk in communities (ARIC) study. Circulation. 2009;119(4):503–14.

    Article  Google Scholar 

  25. Rosengren A, Wallentin L, Simoons M, Gitt AK, Behar S, Battler A, Hasdai D. Age, clinical presentation, and outcome of acute coronary syndromes in the Euroheart acute coronary syndrome survey. Eur Heart J. 2006;27(7):789–95. https://doi.org/10.1093/eurheartj/ehi774.

    Article  Google Scholar 

  26. Arnold AM, Psaty BM, Kuller LH, Burke GL, Manolio TA, Fried LP, Robbins JA, Kronmal RA. Incidence of cardiovascular disease in older Americans: the cardiovascular health study. J Am Geriatr Soc. 2005;53(2):211–8. https://doi.org/10.1111/j.1532-5415.2005.53105.x.

    Article  Google Scholar 

  27. Dunlay SM, Chamberlain AM. Multimorbidity in older patients with cardiovascular Disease. Curr Cardiovasc Risk Rep. 2016;10:3. https://doi.org/10.1007/s12170-016-0491-8.

    Article  Google Scholar 

  28. Feinstein AG. Clinical judgement. New York, NY: Williams & Wilkins; 1967.

    Google Scholar 

  29. Centers for Medicare & Medicaid Services. Chronic Conditions Overview. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/CC_Main.html. Accessed 25 Nov 2015.

  30. Bell SP, Saraf AA. Epidemiology of multimorbidity in older adults with cardiovascular disease. Clin Geriatr Med. 2016;32(2):215–26. https://doi.org/10.1016/j.cger.2016.01.013.

    Article  Google Scholar 

  31. Arnett DK, Goodman RA, Halperin JL, Anderson JL, Parekh AK, Zoghbi WA. AHA/ACC/HHS strategies to enhance application of clinical practice guidelines in patients with cardiovascular disease and comorbid conditions: from the American Heart Association, American College of Cardiology, and U.S. Department of Health and Human Services. J Am Coll Cardiol. 2014;64(17):1851–6.

    Article  Google Scholar 

  32. Breen K, Finnegan L, Vuckovic K, et al. Multimorbidity in patients with acute coronary syndrome is associated with greater mortality, higher readmission rates, and increased length of stay: a systematic review. J Cardiovasc Nurs. 2020;35(6):E99–E110.

    Article  Google Scholar 

  33. Forman DE, Maurer MS, Boyd C, et al. Multimorbidity in older adults with cardiovascular disease. J Am Coll Cardiol. 2018;71:2149–61.

    Article  Google Scholar 

  34. Khezrian M, McNeil CJ, Murray AD, Myint PK. An overview of prevalence, determinants and health outcomes of polypharmacy. Ther Adv Drug Saf. 2020;11:2042098620933741.

    Article  Google Scholar 

  35. Morin L, Johnell K, Laroche ML, Fastbom J, Wastesson JW. The epidemiology of polypharmacy in older adults: register-based prospective cohort study. Clin Epidemiol. 2018;10:289–98.

    Article  Google Scholar 

  36. Walckiers D, Van der Heyden J, Tafforeau J. Factors associated with excessive polypharmacy in older people. Arch Public Health. 2015;73:50.

    Article  Google Scholar 

  37. Young EH, Pan S, Yap AG, Reveles KR, Bhakta K. Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016. PLoS One. 2021;16(8):e0255642.

    Article  CAS  Google Scholar 

  38. Maher RL, et al. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57–65.

    Article  Google Scholar 

  39. Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, Cadoret C, Fish LS, Garber L, Kelleher M, Bates DW. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289(9):1107–16.

    Article  Google Scholar 

  40. Sheikh-Taha M, Asmar M. Polypharmacy and severe potential drug-drug interactions among older adults with cardiovascular disease in the United States. BMC Geriatr. 2021;21(1):233.

    Article  Google Scholar 

  41. Krishnaswami A, Steinman MA, Goyal P, Zullo AR, Anderson TS, Birtcher KK, Goodlin SJ, Maurer MS, Alexander KP, Rich MW, Tjia J, Geriatric Cardiology Section Leadership Council, American College of Cardiology. Deprescribing in older adults with cardiovascular Disease. J Am Coll Cardiol. 2019;73(20):2584–95.

    Article  Google Scholar 

  42. Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56(3):303–8. https://doi.org/10.1001/archneur.56.3.303.

    Article  CAS  Google Scholar 

  43. US Preventive Services Task Force. Screening for cognitive impairment in older adults: US preventive services task force recommendation statement. JAMA. 2020;323(8):757–63. https://doi.org/10.1001/jama.2020.0435.

    Article  Google Scholar 

  44. Petersen RC, Lopez O, Armstrong MJ, Getchius TSD, Ganguli M, Gloss D, Gronseth GS, Marson D, Pringsheim T, Day GS, Sager M, Stevens J, Rae-Grant A. Practice guideline update summary: mild cognitive impairment: report of the guideline development, dissemination, and implementation Subcommittee of the American Academy of Neurology. Neurology. 2018;90:126–35.

    Article  Google Scholar 

  45. Ward A, Tardiff S, Dye C, Arrighi HM. Rate of conversion from prodromal Alzheimer’s disease to Alzheimer’s dementia: a systematic review of the literature. Dement Geriatr Cogn Dis Extra. 2013;3(1):320–32. https://doi.org/10.1159/000354370.

    Article  Google Scholar 

  46. Alzheimer’s disease facts and figures. Alzheimers Dement. 2021;17(3):327–406. https://doi.org/10.1002/alz.12328. Epub 2021 Mar 23

  47. Unverzagt FW, Gao S, Baiyewu O, et al. Prevalence of cognitive impairment: data from the Indianapolis study of health and aging. Neurology. 2001;57(9):1655–62.

    Article  CAS  Google Scholar 

  48. Plassman BL, Langa KM, Fisher GG, Heeringa SG, Weir DR, Ofstedal MB, Burke JR, Hurd MD, Potter GG, Rodgers WL, Steffens DC, McArdle JJ, Willis RJ, Wallace RB. Prevalence of cognitive impairment without dementia in the United States. Ann Intern Med. 2008;148(6):427–34.

    Article  Google Scholar 

  49. Newman AB, Fitzpatrick AL, Lopez O, Jackson S, Lyketsos C, Jagust W, Ives D, Dekosky ST, Kuller LH. Dementia and Alzheimer’s disease incidence in relationship to cardiovascular disease in the Cardiovascular Health Study cohort. J Am Geriatr Soc. 2005;53(7):1101–7.

    Article  Google Scholar 

  50. Deckers K, et al. Coronary heart disease and risk for cognitive impairment or dementia: Systematic review and meta-analysis. PLoS One. 2017;12(9):e0184244. https://doi.org/10.1371/journal.pone.0184244.

    Article  CAS  Google Scholar 

  51. Kasprzak D, Rzeźniczak J, Ganowicz T, et al. A review of acute coronary syndrome and its potential impact on cognitive function. Glob Heart. 2021;16(1):53.

    Article  Google Scholar 

  52. Roberts RO, Knopman DS, Geda YE, Cha RH, Roger VL, Petersen RC. Coronary heart disease is associated with non-amnestic mild cognitive impairment. Neurobiol Aging. 2010;31(11):1894–902.

    Article  Google Scholar 

  53. Gu SZ, Beska B, Chan D, et al. Cognitive decline in older patients with non- ST elevation acute coronary syndrome. J Am Heart Assoc. 2019;8(4):e011218.

    Article  Google Scholar 

  54. American Psychiatric Association DSM-5 Task Force. Diagnostic and statistical manual of mental disorders, 5th ed.: DSM-5. Washington, DC: American Psychiatric Association; 2013.

    Book  Google Scholar 

  55. Watt D, Koziol K, Budding D. Delirium and confusional states. In: Noggle C, Dean R, editors. Disorders in neuropsychiatry. New York: Springer Publishing Company; 2012.

    Google Scholar 

  56. Leslie DL, Marcantonio ER, Zhang Y, Leo-Summers L, Inouye SK. One-year health care costs associated with delirium in the elderly population. Arch Intern Med. 2008;168(1):27–32.

    Article  Google Scholar 

  57. Inouye SK, Westendorp RG, Saczynski JS. Delirium in elderly people. Lancet. 2014;383(9920):911–22.

    Article  Google Scholar 

  58. Grotti S, Falsini G. Delirium in cardiac patients. Eur Heart J. 2017;38(29):2244.

    Article  Google Scholar 

  59. McPherson JA, Wagner CE, Boehm LM, et al. Delirium in the cardiovascular ICU: exploring modifiable risk factors. Crit Care Med. 2013;41(2):405–13.

    Article  Google Scholar 

  60. Vives-Borrás M, Martínez-Sellés M, Ariza-Solé A, et al. Clinical and prognostic implications of delirium in elderly patients with non-ST-segment elevation acute coronary syndromes. J Geriatr Cardiol. 2019;16(2):121–8.

    Google Scholar 

  61. Xue QL. The frailty syndrome: definition and natural history. Clin Geriatr Med. 2011;27(1):1–15.

    Article  CAS  Google Scholar 

  62. Hoogendijk EO, Afilalo J, Ensrud KE, Kowal P, Onder G, Fried LP. Frailty: implications for clinical practice and public health. Lancet. 2019;394:1365–75.

    Article  Google Scholar 

  63. Bandeen-Roche K, Seplaki CL, Huang J, Buta B, Kalyani RR, Varadhan R, Xue QL, Walston JD, Kasper JD. Frailty in older adults: a nationally representative profile in the United States. J Gerontol A Biol Sci Med Sci. 2015;70(11):1427–34.

    Article  Google Scholar 

  64. Abdulla A, Damluji S-EC, Xue Q-L, Hasan RK, Moscucci M, Forman DE, Bandeen-Roche K, Batchelor W, Walston JD, Resar JR, Gerstenblith G. Frailty and cardiovascular outcomes in the National Health and aging trends study. Eur Heart J. 2021;42(37):1.

    Google Scholar 

  65. Fried LP, Tangen CM, Walston J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146–56.

    Article  CAS  Google Scholar 

  66. Abellan van Kan G, Rolland Y, Bergman H, Morley JE, Kritchevsky SB, Vellas B. The I.A.N.A Task Force on frailty assessment of older people in clinical practice. J Nutr Health Aging. 2008;12(1):29–37.

    Article  CAS  Google Scholar 

  67. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.

    Article  Google Scholar 

  68. Rockwood K, Andrew M, Mitnitski A. A comparison of two approaches to measuring frailty in elderly people. J Gerontol A Biol Sci Med Sci. 2007;62(7):738–43.

    Article  Google Scholar 

  69. Rolfson DB, Majumdar SR, Tsuyuki RT, et al. Validity and reliability of the Edmonton frail scale. Age Ageing. 2006;35:526–9.

    Article  Google Scholar 

  70. Gobbens RJ, van Assen MA, Luijkx KG, et al. The Tilburg frailty indicator: psychometric properties. J Am Med Dir Assoc. 2010;11:344–55.

    Article  Google Scholar 

  71. Gilbert T, Neuburger J, Kraindler J, et al. Development and validation of a hospital frailty risk score focusing on older people in acute care settings using electronic hospital records: an observational study. Lancet. 2018;391:1775–82.

    Article  Google Scholar 

  72. Turner G, Clegg A. Best practice guidelines for the management of frailty: a British geriatrics society, age UK and Royal College of general practitioners report. Age Ageing. 2014;43:744–7.

    Article  Google Scholar 

  73. Tonet E, Pavasini R, Biscaglia S, Campo G. Frailty in patients admitted to hospital for acute coronary syndrome: when, how and why? J Geriatr Cardiol. 2019;16:129–37.

    Google Scholar 

  74. Abellan van Kan G, Rolland Y, Andrieu S, et al. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people an international academy on nutrition and aging (IANA) task force. J Nutr Health Aging. 2009;13:881–9.

    Article  CAS  Google Scholar 

  75. Dumurgier J, Elbaz A, Ducimetiere P, et al. Slow walking speed and cardiovascular death in well functioning older adults: prospective cohort study. BMJ. 2009;339:b4460.

    Article  Google Scholar 

  76. Chung KJNC, Wilkinson C, Veerasamy M, Kunadian V. Frailty scores and their utility in older patients with cardiovascular disease. Interv Cardiol. 2021;16:e05.

    Article  Google Scholar 

  77. Blanco S, Ferrières J, Bongard V, Toulza O, Sebai F, Billet S, Biendel C, Lairez O, Lhermusier T, Boudou N, Campelo-Parada F, Roncalli J, Galinier M, Carrié D, Elbaz M, Bouisset F. Prognosis impact of frailty assessed by the Edmonton frail scale in the setting of acute coronary syndrome in the elderly. Can J Cardiol. 2017;33(7):933–9.

    Article  Google Scholar 

  78. Graham MM, Galbraith PD, O’Neill D, Rolfson DB, Dando C, Norris CM. Frailty and outcome in elderly patients with acute coronary syndrome. Can J Cardiol. 2013;29(12):1610–5.

    Article  Google Scholar 

  79. White HD, Westerhout CM, Alexander KP, Roe MT, Winters KJ, Cyr DD, Fox KA, Prabhakaran D, Hochman JS, Armstrong PW, Ohman EM, TRILOGY ACS investigators. Frailty is associated with worse outcomes in non-ST-segment elevation acute coronary syndromes: insights from the TaRgeted platelet inhibition to cLarify the optimal strateGy to medicallY manage acute coronary syndromes (TRILOGY ACS) trial. Eur Heart J Acute Cardiovasc Care. 2016;5(3):231–42.

    Article  Google Scholar 

  80. Damluji AA, Huang J, Bandeen-Roche K, Forman DE, Gerstenblith G, Moscucci M, Resar JR, Varadhan R, Walston JD, Segal JB. Frailty among older adults with acute myocardial infarction and outcomes from percutaneous coronary interventions. J Am Heart Assoc. 2019;8(17):e013686.

    Article  Google Scholar 

  81. Kwok CS, Lundberg G, Al-Faleh H, Sirker A, Van Spall HGC, Michos ED, Rashid M, Mohamed M, Bagur R, Mamas MA. Relation of frailty to outcomes in patients with acute coronary syndromes. Am J Cardiol. 2019;124(7):1002–11.

    Article  Google Scholar 

  82. Dou Q, Wang W, Wang H, et al. Prognostic value of frailty in elderly patients with acute coronary syndrome: a systematic review and meta-analysis. BMC Geriatr. 2019;19:222.

    Article  Google Scholar 

  83. Rodrigues MA, Facchini LA, Thumé E, Maia F. Gender and incidence of functional disability in the elderly: a systematic review. Cad Saude Publica. 2009;25(Suppl 3):S464–76.

    Article  Google Scholar 

  84. Okoro CA, Hollis ND, Cyrus AC, Griffin-Blake S. Prevalence of disabilities and health care access by disability status and type among adults — United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67:882–7.

    Article  Google Scholar 

  85. https://www.un.org/development/desa/disabilities/disability-and-ageing.html.

  86. Spiers NA, Matthews RJ, Jagger C, Matthews FE, Boult C, Robinson TG, Brayne C. Diseases and impairments as risk factors for onset of disability in the older population in England and Wales: findings from the medical research council cognitive function and ageing study. J Gerontol Ser A. 2005;60(2):248–54.

    Article  Google Scholar 

  87. Taş U, Verhagen AP, Bierma-Zeinstra SM, Hofman A, Odding E, Pols HA, Koes BW. Incidence and risk factors of disability in the elderly: the Rotterdam study. Prev Med. 2007;44(3):272–8.

    Article  Google Scholar 

  88. Gill TM, Han L, Gahbauer EA, Leo-Summers L, Murphy TE. Risk factors and precipitants of severe disability among community-living older persons. JAMA Netw Open. 2020;3(6):e206021.

    Article  Google Scholar 

  89. Cui K, Song R, Hui X, Shang Y, Qi X, Buchman AS, David A. Bennett and Weili Xu Association of cardiovascular risk burden with risk and progression of disability: mediating role of cardiovascular disease and cognitive decline. J Am Heart Assoc. 2020;9:e017346.

    Article  Google Scholar 

  90. Chaudhry SI, McAvay G, Ning Y, Allore HG, Newman AB, Gill TM. Risk factors for onset of disability among older persons newly diagnosed with heart failure: the cardiovascular health study. J Card Fail. 2011;17(9):764–70.

    Article  Google Scholar 

  91. Plichart M, Barberger-Gateau P, Tzourio C, et al. Disability and incident coronary heart disease in older community-dwelling adults: the Three-City study. J Am Geriatr Soc. 2010;58(4):636–42.

    Article  Google Scholar 

  92. Afilalo J, Mottillo S, Eisenberg MJ, Alexander KP, Noiseux N, Perrault LP, Morin JF, Langlois Y, Ohayon SM, Monette J, Boivin JF, Shahian DM, Bergman H. Addition of frailty and disability to cardiac surgery risk scores identifies elderly patients at high risk of mortality or major morbidity. Circ Cardiovasc Qual Outcomes. 2012;5(2):222–8.

    Article  Google Scholar 

  93. Mendes de Leon CF, Bang W, Bienias JL, Glass TA, Vaccarino V, Kasl SV. Changes in disability before and after myocardial infarction in older adults. Arch Intern Med. 2005;165(7):763–8.

    Article  Google Scholar 

  94. Abdulaziz K, Perry JJ, Taljaard M, et al. National survey of geriatricians to define functional decline in elderly people with minor trauma. Can Geriatr J. 2016;19(1):2–8.

    Article  Google Scholar 

  95. Dunlop DD, Semanik P, Song J, Manheim LM, Shih V, Chang RW. Risk factors for functional decline in older adults with arthritis. Arthritis Rheum. 2005;52(4):1274–82.

    Article  Google Scholar 

  96. Njegovan V, Hing MM, Mitchell SL, Molnar FJ. The hierarchy of functional loss associated with cognitive decline in older persons. J Gerontol A Biol Sci Med Sci. 2001;56(10):M638–43.

    Article  CAS  Google Scholar 

  97. Hajek A, Luck T, Brettschneider C, Posselt T, Lange C, Wiese B, Steinmann S, Weyerer S, Werle J, Pentzek M, Fuchs A, Stein J, Bickel H, Mösch E, Wagner M, Heser K, Maier W, Scherer JM, Riedel-Heller SG, König HH. Factors affecting functional impairment among elderly Germans - results of a longitudinal study. J Nutr Health Aging. 2017;21(3):299–306.

    Article  CAS  Google Scholar 

  98. Hébert R, Brayne C, Spiegelhalter D. Factors associated with functional decline and improvement in a very elderly community-dwelling population. Am J Epidemiol. 1999;150(5):501–10.

    Article  Google Scholar 

  99. Yaku H, Kato T, Morimoto T, et al. Risk factors and clinical outcomes of functional decline during hospitalisation in very old patients with acute decompensated heart failure: an observational study. BMJ Open. 2020;10(2):e032674.

    Google Scholar 

  100. Kamper AM, Stott DJ, Hyland M, Murray HM, Ford I. Predictors of functional decline in elderly people with vascular risk factors or disease. Age Ageing. 2005;34(5):450–5.

    Article  Google Scholar 

  101. Levine D, Davydow D, Hough C, Langa K, Rogers M, Iwashyna T. Functional disability and cognitive impairment after hospitalization for myocardial infarction and stroke. Circ Cardiovasc Qual Outcomes. 2014:863–71.

    Google Scholar 

  102. Dodson JA, Arnold SA, Reid KJ, Gill TM, Rich MW, Masoudi FA, Spertus JA, Krumholz HM, Alexander KP. Physical function and independence one year following myocardial infarction: observations from the TRIUMPH registry. Am Heart J. 2012;163(5):790–6.

    Article  Google Scholar 

  103. Hajduk AM, Dodson JA, Murphy TE, Tsang S, Geda M, Ouellet GM, Gill TM, Brush JE, Chaudhry SI. Risk model for decline in activities of daily living among older adults hospitalized with acute myocardial infarction: the SILVER-AMI study. J Am Heart Assoc. 2020;9(19):e015555.

    Article  Google Scholar 

  104. Brieger D, Eagle KA, Goodman SG, Steg PG, Budaj A, White K, Montalescot G, GRACE Investigators. Acute coronary syndromes without chest pain, an underdiagnosed and undertreated high-risk group: insights from the global registry of acute coronary events. Chest. 2004;126(2):461–9.

    Article  Google Scholar 

  105. Nanna MG, Hajduk AM, Krumholz HM, Murphy TE, Dreyer RP, Alexander KP, Geda M, Tsang S, Welty FK, Safdar B, Lakshminarayan DK, Chaudhry SI, Dodson JA. Sex-based differences in presentation, treatment, and complications among older adults hospitalized for acute myocardial infarction: the SILVER-AMI study. Circ Cardiovasc Qual Outcomes. 2019;12(10):e005691.

    Article  Google Scholar 

  106. Ouellet GM, Geda M, Murphy TE, Tsang S, Tinetti ME, Chaudhry SI. Prehospital delay in older adults with acute myocardial infarction: the ComprehenSIVe evaluation of risk factors in older patients with acute myocardial infarction study. J Am Geriatr Soc. 2017;65:2391–6.

    Article  Google Scholar 

  107. Silva M, Palhares D, Ribeiro L, Gomes P, Macfarlane P, Ribeiro A, Marcolino M. Prevalence of major and minor electrocardiographic abnormalities in one million primary care Latinos. J Electrocardiol. 2021;64:36–41. https://doi.org/10.1016/j.jelectrocard.2020.11.013. Epub 2020 Dec 2

    Article  Google Scholar 

  108. Marcolino MS, Cury GA, Ribeiro AL. Electrocardiographic abnormalities in the elderly: a study in a large database of primary care patients. J Clin Exp Res Cardiol. 2017;3(2):204.

    Google Scholar 

  109. Molander U, Kumar Dey D, Sundh V, et al. ECG abnormalities in the elderly: prevalence, time and generation trends and association with mortality. Aging Clin Exp Res. 2003;15:488–93.

    Article  Google Scholar 

  110. Gulati M, Levy P, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of CHEST pain. J Am Coll Cardiol. 2021;78(22):e187–285.

    Article  Google Scholar 

  111. Eggers KM, Lind L, Venge P, Lindahl B. Factors influencing the 99th percentile of cardiac troponin I evaluated in community-dwelling individuals at 70 and 75 years of age. Clin Chem. 2013;59(7):1068–73.

    Article  CAS  Google Scholar 

  112. He B, Wang K, Xu P, Zhou Q, Xu J. Determination of age- and sex-specific 99th percentile upper reference limits for high-sensitivity cardiac troponin I in healthy Chinese adults. Cardiology. 2022;147(3):261–70. https://doi.org/10.1159/000523721. Epub ahead of print

    Article  CAS  Google Scholar 

  113. Welsh P, Preiss D, Shah ASV, McAllister D, Briggs A, Boachie C, McConnachie A, Hayward C, Padmanabhan S, Welsh C, Woodward M, Campbell A, Porteous D, Mills NL, Sattar N. Comparison between High-Sensitivity Cardiac Troponin T and Cardiac Troponin I in a Large General Population Cohort. Clin Chem. 2018;64(11):1607–16. https://doi.org/10.1373/clinchem.2018.292086. Epub 2018 Aug 20. PMID: 30126950; PMCID: PMC6398571

    Article  CAS  Google Scholar 

  114. Gore MO, Seliger SL, Defilippi CR, Nambi V, Christenson RH, Hashim IA, Hoogeveen RC, Ayers CR, Sun W, McGuire DK, Ballantyne CM, de Lemos JA. Age- and sex-dependent upper reference limits for the high-sensitivity cardiac troponin T assay. J Am Coll Cardiol. 2014;63(14):1441–8.

    Article  CAS  Google Scholar 

  115. Yancy CW, Jessup M, Bozkurt B, et al. ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines. J Am Coll Cardiol. 2013;61(2013):e78–e140.

    Google Scholar 

  116. Ibanez B, James S, Agewall S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119–77.

    Article  Google Scholar 

  117. Roffi M, Patrono C, Collet JP, et al. 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: task force for the Management of Acute Coronary Syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2016;37(3):267–315.

    Article  CAS  Google Scholar 

  118. 2016 ACC/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA/ACC Guideline for the Management of Patients With Non–ST-Elevation Acute Coronary Syndromes, and 2014 ACC/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery.

    Google Scholar 

  119. Valgimigli M, Bueno H, Byrne RA, et al. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: the task force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2018;39(3):213–60.

    Article  Google Scholar 

  120. Writing Committee Members, Lawton JS, Tamis-Holland JE, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2022;79(2):e21–e129.

    Article  Google Scholar 

  121. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (second international study of infarct survival) collaborative group. Lancet. 1988;2(8607):349–60.

    Google Scholar 

  122. Baigent C, Blackwell L, Collins R, et al., for the Antithrombotic Trialists’ (ATT) CollaborationAspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet. 2009;373:1849–60.

    Article  Google Scholar 

  123. Krumholz HM, Radford MJ, Ellerbeck EF, Hennen J, Meehan TP, Petrillo M, Wang Y, Jencks SF. Aspirin for secondary prevention after acute myocardial infarction in the elderly: prescribed use and outcomes. Ann Intern Med. 1996;124(3):292–8.

    Article  CAS  Google Scholar 

  124. Andreotti F, Rocca B, Husted S, et al. Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on thrombosis. Eur Heart J. 2015;36(46):3238–49. https://doi.org/10.1093/eurheartj/ehv304.

    Article  CAS  Google Scholar 

  125. Coxib and traditional NSAID Trialists’ (CNT) Collaboration, Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, Bombardier C, Cannon C, Farkouh ME, FitzGerald GA, Goss P, Halls H, Hawk E, Hawkey C, Hennekens C, Hochberg M, Holland LE, Kearney PM, Laine L, Lanas A, Lance P, Laupacis A, Oates J, Patrono C, Schnitzer TJ, Solomon S, Tugwell P, Wilson K, Wittes J, Baigent C. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet. 2013;382(9894):769–79. https://doi.org/10.1016/S0140-6736(13)60900-9.

  126. Wilson R, Gazzala J, House J. Aspirin in primary and secondary prevention in elderly adults revisited. South Med J. 2012;105(2):82–6.

    Article  Google Scholar 

  127. Yusuf S, Zhao F, Mehta SR, Chrolavicius S, Tognoni G, Fox KK. Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345(7):494–502. https://doi.org/10.1056/NEJMoa010746.

  128. Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, Malmberg K, Rupprecht H, Zhao F, Chrolavicius S, Copland I, Fox KA, Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial (CURE) Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001;358:527–33.

    Article  CAS  Google Scholar 

  129. Tantry US, Navarese EP, Bliden KP, Gurbel PA. Acetylsalicylic acid and clopidogrel hyporesponsiveness following acute coronary syndromes. Kardiol Pol. 2018;76(9):1312–9.

    Article  Google Scholar 

  130. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361(11):1045–57. https://doi.org/10.1056/NEJMoa0904327.

    Article  CAS  Google Scholar 

  131. Husted S, James S, Becker RC, et al. Ticagrelor versus clopidogrel in elderly patients with acute coronary syndromes: a substudy from the prospective randomized PLATelet inhibition and patient outcomes (PLATO) trial. Circ Cardiovasc Qual Outcomes. 2012;5(5):680–8. https://doi.org/10.1161/CIRCOUTCOMES.111.964395.

    Article  Google Scholar 

  132. Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357(20):2001–15. https://doi.org/10.1056/NEJMoa0706482.

    Article  CAS  Google Scholar 

  133. Riesmeyer JS, Salazar DE, Weerakkody GJ, et al. Relationship between exposure to prasugrel active metabolite and clinical outcomes in the TRITON-TIMI 38 substudy. J Clin Pharmacol. 2012;52:789–97.

    Article  CAS  Google Scholar 

  134. Cayla G, Cuisset T, Silvain J, et al. Platelet function monitoring to adjust antiplatelet therapy in elderly patients stented for an acute coronary syndrome (ANTARCTIC): an open-label, blinded-endpoint, randomised controlled superiority trial. Lancet. 2016;388(10055):2015–22. https://doi.org/10.1016/S0140-6736(16)31323-X.

    Article  CAS  Google Scholar 

  135. Roe MT, Armstrong PW, Fox KA, et al. Prasugrel versus clopidogrel for acute coronary syndromes without revascularization. N Engl J Med. 2012;367(14):1297–309. https://doi.org/10.1056/NEJMoa1205512.

    Article  CAS  Google Scholar 

  136. Roe MT, Goodman SG, Ohman EM, et al. Elderly patients with acute coronary syndromes managed without revascularization: insights into the safety of long-term dual antiplatelet therapy with reduced-dose prasugrel versus standard-dose clopidogrel. Circulation. 2013;128(8):823–33. https://doi.org/10.1161/CIRCULATIONAHA.113.002303.

    Article  CAS  Google Scholar 

  137. Savonitto S, Ferri LA, Piatti L, et al. Comparison of reduced-dose prasugrel and standard-dose clopidogrel in elderly patients with acute coronary syndromes undergoing early percutaneous revascularization. Circulation. 2018;137(23):2435–45.

    Article  CAS  Google Scholar 

  138. Yeh RW, Secemsky EA, Kereiakes DJ, et al. Development and validation of a prediction rule for benefit and harm of dual antiplatelet therapy beyond 1 year after percutaneous coronary intervention. JAMA. 2016;315:1735–49.

    Article  CAS  Google Scholar 

  139. Schmucker J, Fach A, Mata Marin LA, et al. Efficacy and safety of ticagrelor in comparison to clopidogrel in elderly patients with ST-segment-elevation myocardial infarctions. J Am Heart Assoc. 2019;8:e012530.

    Article  Google Scholar 

  140. Szummer K, Montez-Rath ME, Alfredsson J, et al. Comparison between ticagrelor and clopidogrel in elderly patients with an acute coronary syndrome—insights from the SWEDEHEART registry. Circulation. 2020;42:1700–8.

    Article  Google Scholar 

  141. Avezum A, Makdisse M, Spencer F, Gore JM, Fox KA, Montalescot G, Eagle KA, White K, Mehta RH, Knobel E, Collet JP, GRACE Investigators. Impact of age on management and outcome of acute coronary syndrome: observations from the global registry of acute coronary events (GRACE). Am Heart J. 2005;149:67–73.

    Article  Google Scholar 

  142. Alexander KP, Roe MT, Chen AY, Lytle BL, Pollack CV Jr, Foody JM, Boden WE, Smith SC Jr, Gibler WB, Ohman EM, Peterson ED, CRUSADE Investigators. Evolution in cardiovascular care for elderly patients with non-ST–segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative. J Am Coll Cardiol. 2005;46:1479–87.

    Article  Google Scholar 

  143. Rogers WJ, Canto JG, Lambrew CT, Tiefenbrunn AJ, Kinkaid B, Shoultz DA, Frederick PD, Every N. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3. J Am Coll Cardiol. 2000, 36:2056–63.

    Google Scholar 

  144. Capranzano P, Angiolillo DJ. Antithrombotic Management of Elderly Patients with coronary artery disease. JACC Cardiovasc Interv. 2021;14(7):723–38.

    Article  Google Scholar 

  145. Lee SY, Hong MK, Palmerini T, et al. Short-term versus long-term dual antiplatelet therapy after drug-eluting stent implantation in elderly patients: a meta-analysis of individual participant data from 6 randomized trials. JACC Cardiovasc Interv. 2018;11(5):435–43.

    Article  Google Scholar 

  146. Theroux P, Ouimet H, McCans J, Latour JG, Joly P, Levy G, Pelletier E, Juneau M, Stasiak J, deGuise P, Walters DD. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med. 1988;319:1105–11.

    Article  CAS  Google Scholar 

  147. The RISC Group. Risk of myocardial infarction and death during treatment with low dose aspirin and intravenous heparin in men with unstable coronary artery disease. Lancet. 1990;336:827–30.

    Article  Google Scholar 

  148. Cohen M, Adams PC, Parry G, Xiong J, Chamberlain D, Wieczorek I, Fox KA, Chesebro JH, Strain J, Keller C, Kelly A, Lancaster G, Ali J, Kronmal R, Fuster V, Antithrombotic Therapy in Acute Coronary Syndromes Research Group. Combination antithrombotic therapy in unstable rest angina and non-Q-wave infarction in nonprior aspirin users: primary end points analysis from the ATACS trial. Circulation. 1994;89:81–8.

    Article  CAS  Google Scholar 

  149. Gurfinkel EP, Manos EJ, Mejail RI, Cerda MA, Duronto EA, Garcia CN, Daroca AM, Mautner B. Low molecular weight heparin versus regular heparin or aspirin in the treatment of unstable angina and silent ischemia. J Am Coll Cardiol. 1995;26:313–8.

    Article  CAS  Google Scholar 

  150. Fragmin during Instability in Coronary Artery Disease (FRISC) Study Group. Low-molecular-weight heparin during instability in coronary artery disease. Lancet. 1996;347:561–8.

    Article  Google Scholar 

  151. The FRAX.I.S. Study Group. Comparison of two treatment durations (6 days and 14 days) of a low molecular weight heparin with a 6-day treatment of unfractionated heparin in the initial management of unstable angina or non-Q-wave myocardial infarction: FRAX.I.S. (FRAXiparine in Ischaemic syndrome). Eur Heart J. 1999;20:1553–62.

    Article  Google Scholar 

  152. Blazing MA, de Lemos JA, White HD, Fox KA, Verheugt FW, Ardissino D, DiBattiste PM, Palmisano J, Bilheimer DW, Snapinn SM, Ramsey KE, Gardner LH, Hasselblad V, Pfeffer MA, Lewis EF, Braunwald E, Califf RM, A to Z Investigators. Safety and efficacy of enoxaparin vs unfractionated heparin in patients with non-ST-segment elevation acute coronary syndromes who receive tirofiban and aspirin: a randomized controlled trial. JAMA. 2004;292:55–64.

    Article  CAS  Google Scholar 

  153. Ferguson JJ, Califf RM, Antman EM, Cohen M, Grines CL, Goodman S, Kereiakes DJ, Langer A, Mahaffey KW, Nessel CC, Armstrong PW, Avezum A, Aylward P, Becker RC, Biasucci L, Borzak S, Col J, Frey MJ, Fry E, Gulba DC, Guneri S, Gurfinkel E, Harrington R, Hochman JS, Kleiman NS, Leon MB, Lopez-Sendon JL, Pepine CJ, Ruzyllo W, Steinhubl SR, Teirstein PS, Toro-Figueroa L, White H, SYNERGY Trial Investigators. Enoxaparin vs unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes managed with an intended early invasive strategy: primary results of the SYNERGY randomized trial. JAMA. 2004;292:45–54.

    CAS  Google Scholar 

  154. Petersen JL, Mahaffey KW, Hasselblad V, Antman EM, Cohen M, Goodman SG, Langer A, Blazing MA, Le-Moigne-Amrani A, de Lemos JA, Nessel CC, Harrington RA, Ferguson JJ, Braunwald E, Califf RM. Efficacy and bleeding complications among patients randomized to enoxaparin or unfractionated heparin for antithrombin therapy in non-ST-segment elevation acute coronary syndromes: a systematic overview. JAMA. 2004;292:89–96.

    Article  CAS  Google Scholar 

  155. Lopes RD, Alexander KP, Marcucci G, White HD, Spinler S, Col J, Aylward PE, Califf RM, Mahaffey KW. Outcomes in elderly patients with acute coronary syndromes randomized to enoxaparin vs. unfractionated heparin: results from the SYNERGY trial. Eur Heart J. 2008;29:1827–33.

    Article  CAS  Google Scholar 

  156. Campbell NR, Hull RD, Brant R, Hogan DB, Pineo GF, Raskob GE. Aging and heparin-related bleeding. Arch Intern Med. 1996;156:857–60.

    Article  CAS  Google Scholar 

  157. Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med. 2006;354:1464–76.

    Article  CAS  Google Scholar 

  158. Schiele F. Fondaparinux and acute coronary syndromes: update on the OASIS 5–6 studies. Vasc Health Risk Manag. 2010;6:179–87.

    Article  CAS  Google Scholar 

  159. Yusuf S, Mehta SR, Chrolavicius S, Afzal R, Pogue J, Granger CB, Budaj A, Peters RJ, Bassand JP, Wallentin L, Joyner C, Fox KA. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA. 2006;295:1519–30.

    Article  CAS  Google Scholar 

  160. Antithrombotic therapy in the elderly: expert position paper of the European Society of Cardiology Working Group on Thrombosis.

    Google Scholar 

  161. Steg PG, van ‘t Hof A, Hamm CW, Clemmensen P, Lapostolle F, Coste P, Ten Berg J, Van Grunsven P, Eggink GJ, Nibbe L, Zeymer U, Campo dell’ Orto M, Nef H

    Google Scholar 

  162. Steinmetz J, Soulat L, Huber K, Deliargyris EN, Bernstein D, Schuette D, Prats J, Clayton T, Pocock S, Hamon M, Goldstein P. Bivalirudin started during emergency transport for primary PCI. N Engl J Med. 2013;369(23):2207–17.

    Article  Google Scholar 

  163. Shahzad A, Kemp I, Mars C, Wilson K, Roome C, Cooper R, Andron M, Appleby C, Fisher M, Khand A, Kunadian B, Mills JD, Morris JL, Morrison WL, Munir S, Palmer ND, Perry RA, Ramsdale DR, Velavan P, Stables RH. Unfractionated heparin versus bivalirudin in primary percutaneous coronary intervention (HEAT-PPCI): an open-label, single Centre, randomised controlled trial. Lancet. 2014;384:1849–58.

    Article  CAS  Google Scholar 

  164. Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD, Sarembock IJ, Cohen DJ, Spriggs D, Ebrahimi R, Keren G, Carr J, Cohen EA, Betriu A, Desmet W, Kereiakes DJ, Rutsch W, Wilcox RG, de Feyter PJ, Vahanian A, Topol EJ. Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. JAMA. 2003;289(7):853–63.

    Article  CAS  Google Scholar 

  165. Lopes RD, Alexander KP, Manoukian SV, Bertrand ME, Feit F, White HD, Pollack CV Jr, Hoekstra J, Gersh BJ, Stone GW, Ohman EM. Advanced age, antithrombotic strategy, and bleeding in non-ST-segment elevation acute coronary syndromes: results from the ACUITY (acute catheterization and urgent intervention triage strategy) trial. J Am Coll Cardiol. 2009;53(12):1021–30.

    Article  CAS  Google Scholar 

  166. Navarese EP, Schulze V, Andreotti F, Kowalewski M, Kołodziejczak M, Kandzari DE, Rassaf T, Gorny B, Brockmeyer M, Meyer C, Berti S, Kubica J, Kelm M, Valgimigli M. Comprehensive meta-analysis of safety and efficacy of bivalirudin versus heparin with or without routine glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndrome. JACC Cardiovasc Interv. 2015;8(1 Pt B):201–13. https://doi.org/10.1016/j.jcin.2014.10.003.

  167. Hirsh J, Dalen JE, Anderson DR, Poller L, Bussey H, Ansell J, Deykin D, Brandt JT. Oral anticoagulants: mechanism of action, clinical effectiveness, and optimal therapeutic range. Chest. 1998;114(5 Suppl):445S–469S. https://doi.org/10.1378/chest.114.5_supplement.445s.

    Google Scholar 

  168. Wright IS. The use of the anticoagulants in the treatment of diseases of the heart and blood vessels. Ann Intern Med. 1949;30:80–91.

    Article  CAS  Google Scholar 

  169. Rothberg MB, Celestin C, Fiore LD, et al. Warfarin plus aspirin after myocardial infarction or the acute coronary syndrome: meta-analysis with estimates of risk and benefit. Ann Intern Med. 2005;143:241–50.

    Article  CAS  Google Scholar 

  170. Andreotti F, Testa L, Biondi-Zoccai GG, Crea F. Aspirin plus warfarin compared to aspirin alone after acute coronary syndromes: an updated and comprehensive meta-analysis of 25,307 patients. Eur Heart J. 2006;27:519–26.

    Article  CAS  Google Scholar 

  171. Oldgren J, et al. Dabigatran vs. placebo in patients with acute coronary syndromes on dual antiplatelet therapy: a randomized, double-blind, phase II trial. Eur Heart J. 2011;32:2781–9.

    Article  CAS  Google Scholar 

  172. Uchino K, Hernandez AV. Dabigatran association with higher risk of acute coronary events: meta-analysis of noninferiority randomized controlled trials. Arch Intern Med. 2012;172(5):397–402. https://doi.org/10.1001/archinternmed.2011.1666. Epub 2012 Jan 9

    Article  CAS  Google Scholar 

  173. Alexander JH, et al. Apixaban, an oral, direct, selective factor Xa inhibitor, in combination with antiplatelet therapy after acute coronary syndrome: results of the apixaban for prevention of acute ischemic and safety events (APPRAISE) trial. Circulation. 2009;119:2877–85.

    Article  Google Scholar 

  174. Alexander JH, Lopes RD, James S, et al. Apixaban with antiplatelet therapy after acute coronary syndrome (APPRAISE-2). N Engl J Med. 2011;365:699–708.

    Article  CAS  Google Scholar 

  175. Mega JL, Braunwald E, Mohanavelu S, Burton P, Poulter R, Misselwitz F, Hricak V, Barnathan ES, Bordes P, Witkowski A, Markov V, Oppenheimer L, Gibson CM. ATLAS ACS-TIMI 46 study group. Rivaroxaban versus placebo in patients with acute coronary syndromes (ATLAS ACS-TIMI 46): a randomised, double-blind, phase II trial. Lancet. 2009;374(9683):29–38.

    Article  CAS  Google Scholar 

  176. Mega JL, Braunwald E, Wiviott SD, Bassand JP, Bhatt DL, Bode C, Burton P, Cohen M, Cook-Bruns N, Fox KA, Goto S, Murphy SA, Plotnikov AN, Schneider D, Sun X, Verheugt FW, Gibson CM. Rivaroxaban in patients with a recent acute coronary syndrome. N Engl J Med. 2012;366(1):9–19.

    Article  CAS  Google Scholar 

  177. http://www.ema.europa.eu/docs/en_GB/document_library/EPAR-Product_Information/human/000944/WC500057108.pdf.

  178. Michniewicz E, Mlodawska E, Lopatowska P, et al. Patients with atrial fibrillation and coronary artery disease - double trouble. Adv Med Sci. 2018;63(1):30–5.

    Article  Google Scholar 

  179. Dewilde WJ, Oirbans T, Verheugt FW, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet. 2013;381(9872):1107–15. https://doi.org/10.1016/S0140-6736(12)62177-1.

    Article  CAS  Google Scholar 

  180. Cannon CP, Bhatt DL, Oldgren J, Lip GYH, Ellis SG, Kimura T, Maeng M, Merkely B, Zeymer U, Gropper S, Nordaby M, Kleine E, Harper R, Manassie J, Januzzi JL, Ten Berg JM, Steg PG, Hohnloser SH, RE-DUAL PCI Steering Committee and Investigators. Dual antithrombotic therapy with dabigatran after PCI in atrial fibrillation. N Engl J Med. 2017;377(16):1513–24.

    Article  CAS  Google Scholar 

  181. ten Berg JM, Steg PG, Bhatt DL, et al. Comparison of the effect of age (<75 versus ≥75) on the efficacy and safety of dual therapy (dabigatran + clopidogrel or ticagrelor) versus triple therapy (warfarin + aspirin + clopidogrel or ticagrelor) in patients with atrial fibrillation after percutaneous coronary intervention (from the RE-DUAL PCI trial). Am J Cardiol. 2020;125:735–43.

    Article  Google Scholar 

  182. Lopes RD, Heizer G, Aronson R, Vora AN, Massaro T, Mehran R, Goodman SG, Windecker S, Darius H, Li J, Averkov O, Bahit MC, Berwanger O, Budaj A, Hijazi Z, Parkhomenko A, Sinnaeve P, Storey RF, Thiele H, Vinereanu D, Granger CB, Alexander JH, AUGUSTUS Investigators. Antithrombotic therapy after acute coronary syndrome or PCI in atrial fibrillation. N Engl J Med. 2019;380(16):1509–24.

    Article  CAS  Google Scholar 

  183. Gibson CM, Mehran R, Bode C, Halperin J, Verheugt FW, Wildgoose P, Birmingham M, Ianus J, Burton P, van Eickels M, Korjian S, Daaboul Y, Lip GY, Cohen M, Husted S, Peterson ED, Fox KA. Prevention of bleeding in patients with atrial fibrillation undergoing PCI. N Engl J Med. 2016;375(25):2423–34.

    Article  CAS  Google Scholar 

  184. Vranckx P, Valgimigli M, Eckardt L, et al. Edoxaban-based versus vitamin K antagonist-based antithrombotic regimen after successful coronary stenting in patients with atrial fibrillation (ENTRUST-AF PCI): a randomised, open-label, phase 3b trial. Lancet. 2019;394(10206):1335–43. https://doi.org/10.1016/S0140-6736(19)31872-0.

    Article  CAS  Google Scholar 

  185. Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Gruppo Italiano per lo studio della Streptochinasi nell’Infarto Miocardico (GISSI). Lancet. 1986;1(8478):397–402.

    Google Scholar 

  186. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. fibrinolytic therapy trialists’ (FTT) collaborative group. Lancet. 1994;343(8893):311–22.

    Google Scholar 

  187. White HD. Thrombolytic therapy in the elderly. Lancet. 2000;356:2028–30.

    Article  CAS  Google Scholar 

  188. Thiemann DR, Coresh J, Schulman SP, et al. Lack of benefit for intravenous thrombolysis in patients with myocardial infarction who are older than 75 years. Circulation. 2000;101(19):2239.

    Article  CAS  Google Scholar 

  189. Berger AK, Radford MJ, Wang Y, Krumholz HM. Thrombolytic therapy in older patients. J Am Coll Cardiol. 2000;36(2):366.

    Article  CAS  Google Scholar 

  190. Stenestrand U, Wallentin L. Register of information and knowledge about Swedish heart intensive care admissions (RISK-HIA). Fibrinolytic therapy in patients 75 years and older with ST-segment-elevation myocardial infarction: one-year follow-up of a large prospective cohort. Arch Intern Med. 2003;163(8):965–71.

    Article  Google Scholar 

  191. White HD, Barbash GI, Califf RM, et al. Age and outcome with contemporary thrombolytic therapy. Results from the GUSTO-I trial. Global utilization of streptokinase and TPA for occluded coronary arteries trial. Circulation. 1996;94(8):1826–33. https://doi.org/10.1161/01.cir.94.8.1826.

    Article  CAS  Google Scholar 

  192. Longstreth WT Jr, Litwin PE, Weaver WD. Myocardial infarction, thrombolytic therapy, and stroke. A community-based study. The MITI project group. Stroke. 1993;24(4):587–90. https://doi.org/10.1161/01.str.24.4.587.

    Article  Google Scholar 

  193. Gurwitz JH, Gore JM, Goldberg RJ, et al. Risk for intracranial hemorrhage after tissue plasminogen activator treatment for acute myocardial infarction participants in the National Registry of myocardial infarction 2. Ann Intern Med. 1998;129(8):597.

    Article  CAS  Google Scholar 

  194. Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-2) Investigators, Van De Werf F, Adgey J, et al. Single-bolus tenecteplase compared with front-loaded alteplase in acute myocardial infarction: the ASSENT-2 double-blind randomised trial. Lancet. 1999;354(9180):716–22.

    Article  Google Scholar 

  195. Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 Investigators. Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction. Lancet. 2001;358(9282):605–13.

    Article  Google Scholar 

  196. Antman EM, Morrow DA, McCabe CH, et al. Enoxaparin versus unfractionated heparin with fibrinolysis for ST-elevation myocardial infarction. N Engl J Med. 2006;354(14):1477–88.

    Article  CAS  Google Scholar 

  197. Chen ZM, Jiang LX, Chen YP, et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005;366(9497):1607–21.

    Article  CAS  Google Scholar 

  198. Sabatine MS, Cannon CP, Gibson CM, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med. 2005;352(12):1179–89.

    Article  CAS  Google Scholar 

  199. Armstrong PW, Gershlick AH, Goldstein P, et al. STREAM Investigative Team. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2013;368(15):1379–87.

    Article  CAS  Google Scholar 

  200. Armstrong PW, Zheng Y, Westerhout CM, et al. Reduced dose tenecteplase and outcomes in elderly ST-segment elevation myocardial infarction patients: insights from the strategic reperfusion early after myocardial infarction trial. Am Heart J. 2015;169(6):890–898 e1.

    Article  CAS  Google Scholar 

  201. Berwanger O, Nicolau JC, Carvalho AC, et al. Ticagrelor vs clopidogrel after fibrinolytic therapy in patients with ST-elevation myocardial infarction: a randomized clinical Trial. JAMA Cardiol. 2018;3(5):391–9.

    Article  Google Scholar 

  202. Armstrong PW, Bogaerts K, Welsh R, et al. The second strategic reperfusion early after myocardial infarction (STREAM-2) study optimizing pharmacoinvasive reperfusion strategy in older ST-elevation myocardial infarction patients. Am Heart J. 2020;226:140–6.

    Article  CAS  Google Scholar 

  203. Grines CL, Browne KF, Marco J, Rothbaum D, Stone GW, O’Keefe J, Overlie P, Donohue B, Chelliah N, Timmis GC, et al. The Primary Angioplasty in Myocardial Infarction Study Group. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. N Engl J Med. 1993;328:673–9.

    Article  CAS  Google Scholar 

  204. Stone GW, Grines CL, Browne KF, Marco J, Rothbaum D, O’Keefe J, Hartzler GO, Overlie P, Donohue B, Chelliah N, et al. Predictors of in-hospital and 6-month outcome after acute myocardial infarction in the reperfusion era: the primary angioplasty in myocardial infarction (PAMI) trial. J Am Coll Cardiol. 1995;25:370–7.

    Article  CAS  Google Scholar 

  205. The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med. 1997;336:1621–8.

    Article  Google Scholar 

  206. Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, Kelbaek H, Thayssen P, Abildgaard U, Pedersen F, Madsen JK, Grande P, Villadsen AB, Krusell LR, Haghfelt T, Lomholt P, Husted SE, Vigholt E, Kjaergard HK, Mortensen LS, DANAMI-2 Investigators. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003;349:733–42.

    Article  Google Scholar 

  207. de Boer MJ, Ottervanger JP, van’t Hof AW, Hoorntje JC, Suryapranata H, Zijlstra F, Zwolle Myocardial Infarction Study Group. Reperfusion therapy in elderly patients with acute myocardial infarction: a randomized comparison of primary angioplasty and thrombolytic therapy. J Am Coll Cardiol. 2002;39:1723–8.

    Article  Google Scholar 

  208. Grines C. Senior PAMI: a prospective randomized trial of primary angioplasty and thrombolytic therapy in elderly patients with acute myocardial infarction. Presented at Transcatheter Cardiovascular Therapeutics; Washington, D; October 16–21, 2005.

    Google Scholar 

  209. https://www.acc.org/latest-in-cardiology/clinical-trials/2010/02/23/19/21/senior-pami.

  210. Bueno H, Betriu A, Heras M, et al. Primaryangioplasty vs. fibrinolysis in very old patientswith acute myocardial infarction: TRIANA (TRatamiento del Infarto Agudo de miocardio eN Ancianos) randomized trial and pooled analysis with previous studies. Eur Heart J. 2011;32:51–60.

    Article  Google Scholar 

  211. Goel K, Gupta T, Gulati R, et al. Temporal trends and outcomes of percutaneous coronary interventions in nonagenarians: a National Perspective. JACC Cardiovasc Interv. 2018;11(18):1872–82. https://doi.org/10.1016/j.jcin.2018.06.026.

    Article  Google Scholar 

  212. Fach A, Bünger S, Zabrocki R, et al. Comparison of outcomes of patients with STsegment elevation myocardial infarction treated by primary percutaneous coronary intervention analyzed by age groups (<75, 75 to 85, and >85 years);(results from the Bremen STEMI Registry). Am J Cardiol. 2015;116:1802–9.

    Article  Google Scholar 

  213. Zuhdi ASM, Ahmad WAW, Zaki RA, et al. Acute coronary syndrome in the elderly: the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome registry. Singap Med J. 2016;57:191–7.

    Article  Google Scholar 

  214. Pek PP, Zheng H, Ho AFW, et al. Comparison of epidemiology, treatments and outcomes of ST segment elevation myocardial infarction between young and elderly patients. Emerg Med J. 2018;35(5):289–96. https://doi.org/10.1136/emermed-2017-206754.

    Article  Google Scholar 

  215. Albert Ariza-Solé A, Alegre O, Elola FJ, et al. Management of myocardial infarction in the elderly. Insights from Spanish minimum basic data set. Eur Heart J Acute Cardiovasc Care. 2019;8:242–51.

    Article  Google Scholar 

  216. Kvakkestad KM, Abdelnoor M, Claussen PA, Eritsland J, Fossum E, Halvorsen S. Long-term survival in octogenarians and older patients with ST-elevation myocardial infarction in the era of primary angioplasty: a prospective cohort study. Eur Heart J Acute Cardiovasc Care. 2016;5(3):243–52. https://doi.org/10.1177/2048872615574706.

    Article  Google Scholar 

  217. Puymirat E, Aissaoui N, Cayla G, et al. Changes in one-year mortality in elderly patients admitted with acute myocardial infarction in relation with early management. Am J Med. 2017;130(5):555–63. https://doi.org/10.1016/j.amjmed.2016.12.005.

    Article  Google Scholar 

  218. Rivero F, Bastante T, Cuesta J, Benedicto A, Salamanca J, Restrepo JA, Aguilar R, Gordo F, Batlle M, Alfonso F. Factors associated with delays in seeking medical attention in patients with ST-segment elevation acute coronary syndrome. Rev Esp Cardiol. 2016;69:279–85.

    Article  Google Scholar 

  219. The TIMI IIIB Investigators. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non–Q-wave myocardial infarction: results from the TIMI IIIB Trial. Circulation. 1994;89:1545–56.

    Article  Google Scholar 

  220. Anderson HV, Cannon CP, Stone PH, Williams DO, McCabe CH, Knatterud GL, Thompson B, Willerson JT, Braunwald E. One-year results of the thrombolysis in myocardial infarction (TIMI) IIIB clinical trial: a randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus early conservative strategies in unstable angina and non-Q-wave myocardial infarction. J Am Coll Cardiol. 1995;26:1643–50.

    Article  CAS  Google Scholar 

  221. Boden WE, O’Rourke RA, Crawford MH, Blaustein AS, Deedwania PC, Zoble RG, Wexler LF, Kleiger RE, Pepine CJ, Ferry DR, Chow BK, Lavori PW, Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigators. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. N Engl J Med. 1998;338:1785–92.

    Article  CAS  Google Scholar 

  222. FRagmin and Fast Revascularisation during InStability in Coronary artery disease (FRISC II) Investigators. Invasive compared with noninvasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. Lancet. 1999;354:708–15.

    Article  Google Scholar 

  223. Fox KA, Poole-Wilson PA, Henderson RA, Clayton TC, Chamberlain DA, Shaw TR, Wheatley DJ, Pocock SJ, Randomized Intervention Trial of unstable Angina Investigators. Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial: randomised intervention Trial of unstable angina. Lancet. 2002;360:743–51.

    Article  CAS  Google Scholar 

  224. de Winter RJ, Windhausen F, Cornel JH, Dunselman PH, Janus CL, Bendermacher PE, Michels HR, Sanders GT, Tijssen JG, Verheugt FW, Invasive versus Conservative Treatment in Unstable Coronary Syndromes (ICTUS) Investigators. Early invasive versus selectively invasive management for acute coronary syndromes. N Engl J Med. 2005;353:1095–104.

    Article  Google Scholar 

  225. Damman P, Clayton T, Wallentin L, et al. Effects of age on longterm outcomes after a routine invasive or selective invasivestrategy in patients presenting with non-ST segment elevationacute coronary syndromes: a collaborative analysis of individualdata from the FRISC II - ICTUS - RITA-3 (FIR) trials. Heart. 2012;98(3):207–13.

    Article  Google Scholar 

  226. Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N, Neumann FJ, Robertson DH, DeLucca PT, DiBattiste PM, Gibson CM, Braunwald E, TACTICS (Treat Angina with Aggrastat and Determine Cost of Therapy with an Invasive or Conservative Strategy)–Thrombolysis in Myocardial Infarction 18 Investigators. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med. 2001;344:1879–87.

    Article  CAS  Google Scholar 

  227. Savonitto S, Cavallini C, Petronio AS, et al. Italian Elderly ACS Trial Investigators. Early aggressive versus initially conservative treatment in elderly patients with non-ST-segment elevation acute coronary syndrome: a randomized controlled trial. JACC Cardiovasc Interv. 2012;5(9):906–16.

    Article  Google Scholar 

  228. Tegn N, Abdelnoor M, Aaberge L, et al. After Eighty Study Investigators. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (after eighty study): an open-label randomised controlled trial. Lancet. 2016;387(10023):1057–65.

    Article  Google Scholar 

  229. Sanchis J, Núñez E, Barrabés JA, Marín F, Consuegra-Sánchez L, Ventura S, Valero E, Roqué M, Bayés-Genís A, del Blanco BG, Dégano I, Núñez J. Randomized comparison between the invasive and conservative strategies in comorbid elderly patients with non-ST elevation myocardial infarction. Eur J Intern Med. 2016;35:89–94.

    Article  Google Scholar 

  230. Hirlekar G, Libungan B, Karlsson T, Bäck M, Herlitz J, Albertsson P. Percutaneous coronary intervention in the very elderly with NSTE-ACS: the randomized 80+ study. Scand Cardiovasc J. 2020;54:315–21.

    Article  Google Scholar 

  231. de Belder A, Myat A, Blaxill J, Haworth P, O’Kane P, Hatrick R, Aggarwal RK, Davie A, Smith W, Gerber R, Byrne J, Adamson D, Witherow F, Alsanjari O, Wright J, Robinson DR, Hildick-Smith D. Revascularisation or medical therapy in elderly patients with acute anginal syndromes: the RINCAL randomised trial. EuroIntervention. 2021;17:67–74.

    Article  Google Scholar 

  232. Garg A, Garg L, Agarwal M, et al. Routine invasive versus selective invasive strategy in elderly patients older than 75 years with non-ST-segment elevation acute coronary syndrome: a systematic review and meta-analysis. Mayo Clin Proc. 2018;93(4):436–44. https://doi.org/10.1016/j.mayocp.2017.11.022.

    Article  Google Scholar 

  233. Kaura A, Sterne JAC, Trickey A, et al. Invasive versus non-invasive management of older patients with non-ST elevation myocardial infarction (SENIOR-NSTEMI): a cohort study based on routine clinical data. Lancet. 2020;396(10251):623–34. https://doi.org/10.1016/S0140-6736(20)30930-2.

    Article  CAS  Google Scholar 

  234. Zaman MJ, Stirling S, Shepstone L, et al. The association between older age and receipt of care and outcomes in patients with acute coronary syndromes: a cohort study of the myocardial Ischaemia National Audit Project (MINAP). Eur Heart J. 2014;35(23):1551–8. https://doi.org/10.1093/eurheartj/ehu039.

    Article  Google Scholar 

  235. https://clinicaltrials.gov/ct2/show/NCT03052036

  236. Leng WX, Yang J, Li W, Wang Y, Yang YJ, DEAR-OLD investigators. Rationale and design of the DEAR-OLD trial: randomized evaluation of routinely deferred versus EARly invasive strategy in elderly patients of 75 years or OLDer with non-ST-elevation myocardial infarction. Am Heart J. 2018;196:65–73. https://doi.org/10.1016/j.ahj.2017.10.022.

    Article  Google Scholar 

  237. Madhavan MV, Gersh BJ, Alexander KP, Granger CB, Stone GW. Coronary artery disease in patients ≥80 years of age. J Am Coll Cardiol. 2018;71(18):2015–40.

    Article  Google Scholar 

  238. Olufajo OA, Wilson A, Zeineddin A, Williams M, Aziz S. Coronary artery bypass grafting among older adults: patterns, outcomes, and trends. J Surg Res. 2021;258:345–51.

    Article  Google Scholar 

  239. Alkhouli M, Alqahtani F, Kalra A, et al. Trends in characteristics and outcomes of patients undergoing coronary revascularization in the United States, 2003-–2016. JAMA Netw Open. 2020;3(2):e1921326.

    Article  Google Scholar 

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Authors and Affiliations

  1. University of Louisville School of Medicine, Louisville, KY, USA

    Amit Rout

  2. Geriatrics and Palliative Care Medicine, University of Chicago, Chicago, IL, USA

    Sheraz Hussain

  3. Cardiovascular Disease, Advocate Christ Medical Center, Oak Lawn, IL, USA

    Sheraz Hussain

  4. The Inova Center of Outcomes Research, Inova Heart and Vascular Institute, Falls Church, VA, USA

    Abdulla A. Damluji

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    Thorsten M. Leucker

  2. School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Gary Gerstenblith

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Dr. Damluji receives research funding from the Pepper Scholars Program of the Johns Hopkins University Claude D. Pepper Older Americans Independence Center funded by the National Institute on Aging P30-AG021334 and mentored patient-oriented research career development award from the National Heart, Lung, and Blood Institute K23-HL153771-01.

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Rout, A., Hussain, S., Damluji, A.A. (2023). Acute Coronary Syndrome in the Older Adult Populations. In: Leucker, T.M., Gerstenblith, G. (eds) Cardiovascular Disease in the Elderly. Contemporary Cardiology. Humana, Cham. https://doi.org/10.1007/978-3-031-16594-8_10

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