Evolving role of revascularization in older adults with acute coronary syndrome

Revascularization following acute coronary syndrome reduces morbidity and, in some cases, improves survival. Revascularization is part of a care plan that must include optimal medical therapy for secondary prevention and also counseling to promote healthy behaviors. The use of revascularization and guideline-recommended therapies declines as patients age, which may be attributed, in part, to geriatric or "age-associated" vulnerability. Such common geriatric factors include functional decline, comorbid illness, heightened risks of adverse procedural complications or adverse drug reactions, and clinician-perceived decisions regarding risk versus benefit. Patient selection for invasive management must consider patient preferences and risks from age-related multimorbidity. In selected older adults for whom revascularization is favored, advances in percutaneous coronary practices have paralleled improvements in cardiac surgery, both of which are employed to treat older adults in the setting of acute ischemic heart disease.