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Giovanna Liuzzo, Carlo Patrono, Weekly Journal Scan: Do older patients with non-ST-segment elevation myocardial infarction receive any benefit from a routine invasive strategy?, European Heart Journal, Volume 46, Issue 3, 14 January 2025, Pages 329–331, https://doi.org/10.1093/eurheartj/ehae684
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Comment on the article ‘Invasive treatment strategy for older patients with myocardial infarction’ presented at ESC Congress 2024 in London and simultaneously published in The New England Journal of Medicine; https://doi.org/10.1056/NEJMoa2407791.
Comment
In higher-risk patients with NSTEMI, current guidelines for the management of acute coronary syndromes (ACS) recommend an invasive strategy over medical therapy alone.2,3 Guidelines also include specific recommendations for the elderly, who now represent an increasing proportion of ACS patients, emphasizing that the same diagnostic and treatment strategies should be applied to both older and younger adults with ACS, while carefully assessing the risks and benefits of different treatment approaches.2,3 However, older NSTEMI patients are less likely to receive guideline-recommended care, including the use of an invasive strategy.4 This may be due to several factors. Older patients are often underrepresented in clinical trials evaluating NSTEMI treatment strategies, leading to a lack of robust, evidence-based recommendations for their care.5 This evidence gap, combined with clinician or patient concerns about procedural risks or potential futility, often leads to a more conservative approach.