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Invasive strategy in elderly patients with acute coronary syndrome in 2018: close to the truth?

Journal of Geriatric Cardiology 2019年第2期16卷 114-120页

作者： Sergio García-Blas clara bonanad Juan Sanchis Servei de Cardiologia Hospital Clínic Universitari de València INCLIVA Universitat de ValènciaCIBERCV

Elderly population constitutes an increasingly larger proportion of patients admitted for acute coronary syndromes(ACS).The optimal management of ACS in these patients is still a challenge due to their clinical peculiarities and the paucity of specific data,and they have been traditionally managed more conservatively mainly based on subjective criteria.In ST^segment elevation acute myocardial infarction urgent reperfusion is the standard of care and there is no upper age limit.In non-ST segment elevation acute myocardial infarction evidence is controversial,incomplete and mainly focused on chronological age.While a strict conservative strategy should be avoided,routine invasive strategy may reduce the occurrence of myocardial infarction and need for revascularization at follow-up with no established benefit in terms of mortality.Clinical characteristics associated with aging,such as comorbidities and frailty,further discriminate patient's risk beyond age.Evidence is scarce,but it suggests that these features may modulate the benefit of invasive strategy in this population.Ongoing trials should clarify the optimal management of ACS based on these parameters.

关键词： Acute coronary syndromes Comorbidity Frailty Percutaneous coronary intervention The elderly

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Cardiovascular prevention in elderly patients

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Journal of Geriatric Cardiology 2022年第5期19卷 377-392页

作者： clara bonanad Rosa Fernández-Olmo Sergio García-Blas Jose Antonio Alarcon Pablo Díez-Villanueva Carmen Rus Mansilla Héctor García-Pardo Pablo Toledo Ana Ayesta Eva Pereira Antoni Carol Almudena Castro-Conde Carmen de Pablo-Zarzoso Manuel Martínez-Sellés Vicente Arrarte Raquel Campuzano Albert Ariza-Solé Servicio de Cardiología Hospital Clínico Universitario de ValenciaValenciaSpain Instituto de Investigación Sanitaria INCLIVA ValenciaSpain Servicio Cardiología Hospital Universitario de Jaén Spain Servicio Cardiología Hospital de Donosti Spain Servicio de Cardiología Hospital Universitario La Princesa de MadridSpain Servicio de Cardiología Hospital Alto Gudalquivir de AndújarJaénSpain Servicio de Cardiología Hospital Rio Hortega de ValladolidSpain Servicio Cardiología Hospital Clínico San Cecilio de Granada Spain Servicio de Cardiología Hospital Universitario Central de AsturiasSpain Servicio de Cardiologia Hospital de LugoSpain Servicio de Cardiología Hospital Moisés Broggi de BarcelonaSpain Servicio de Cardiología Hospital Universitario de la Paz de Madrid Spain Servicio de Cardiología Hospital Ramón y Cajal de MadridSpain Department of Cardiology.Hospital Universitario Gregorio Marañón CIBERCV.Universidad EuropeaUniversidad Compluten Servicio de Cardiología del Hospital General de Alicante Spain Servicio de Cardiología Hospital Universitario Fundación de Alcorcón de MadridSpain Servicio de Cardiología Hospital Bellvitge de BarcelonaBioheartGrup de Malalties CardiovascularsInstitut d’InvestigacióBiomèdica de BellvitgeIDIBELLL’Hospitalet de LlobregatBarcelonaSpain

In recent decades,life expectancy has been increasing significantly.In this scenario,health interventions are ne-cessary to improve prognosis and quality of life of elderly with cardiovascular risk factors and cardiovascular disease.However,the number of elderly patients included in clinical trials is low,thus current clinical practice guidelines do not include specific re-commendations.This document aims to review prevention recommendations focused in patients≥75 years with high or very high cardiovascular risk,regarding objectives,medical treatment options and also including physical exercise and their inclusion in cardiac rehabilitation programs.Also,we will show why geriatric syndromes such as frailty,dependence,cognitive impair-ment,and nutritional status,as well as comorbidities,ought to be considered in this population regarding their important pro-gnostic impact.

关键词： prevention patients cardiovascular

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