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Acute coronary syndromes in the elderly.

机译：老年人急性冠脉综合征。

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The elderly constitute an increasingly important sector of patients with acute coronary syndromes (ACS), although they have been under-represented in many therapeutic trials. Elderly patients with ACS usually have more complex co-morbidities and worse outcomes than their younger counterparts, and they are less likely to undergo revascularisation or to receive short- and long-term evidence-based medications. The most common ACS in the elderly is non-ST-segment elevation myocardial infarction (STEMI), which is associated with high mortality. For this reason, elderly patients with non-STEMI and unstable angina should be treated invasively early in the course of the episode. In elderly patients with STEMI, primary angioplasty seems to be more effective than fibrinolysis, and in patients aged >85 years a more conservative approach to fibrinolysis is also warranted because of the higher risk for cerebral haemorrhage. Therefore, angioplasty should be preferred when feasible, although more trials are needed before this strategy can definitely be documented as the preferred option. Drug-eluting stents afford greater benefit than bare metal stents in elderly patients and are more cost effective. After fibrinolysis, low-molecular-weight heparin appears to be superior to unfractionated heparin in elderly patients with STEMI but major bleeding and intracranial haemorrhages occur more frequently, especially in women aged >75 years. It is very important to understand that the elderly with ACS constitute a subgroup of atherosclerotic patients for whom decision making must be guided by the patients''physiological age' (determined by their physical condition and other co-morbidities) and not strictly by their 'chronological age'.
机译：尽管老年人在许多治疗试验中的代表性不足，但在急性冠脉综合征（ACS）患者中，老年人却越来越重要。老年ACS患者通常比年轻患者更复杂的合并症和较差的结局，并且他们不太可能进行血管重建或接受短期和长期的循证医学治疗。老年人中最常见的ACS是非ST段抬高型心肌梗塞（STEMI），与高死亡率相关。因此，患有非STEMI和不稳定型心绞痛的老年患者应在发作过程中尽早进行侵入性治疗。在老年STEMI患者中，原发性血管成形术似乎比纤维蛋白溶解更有效，并且对于年龄大于85岁的患者，由于脑出血的风险较高，因此也应采取更为保守的纤维蛋白溶解方法。因此，在可行的情况下应首选血管成形术，尽管在将这种策略明确记录为首选方案之前还需要进行更多试验。在老年患者中，药物洗脱支架比裸金属支架具有更大的优势，并且更具成本效益。纤维蛋白溶解后，低分子量肝素似乎在老年STEMI患者中优于普通肝素，但是大出血和颅内出血的发生频率更高，尤其是在年龄大于75岁的女性中。非常重要的是要理解，ACS患者是动脉粥样硬化患者的一个亚组，对于这些患者，决策必须由患者的“生理年龄”（由他们的身体状况和其他合并症决定）而不是由他们的“生理年龄”决定。年代年龄”。

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