Evidence-based management of
acute coronary syndromes (ACS) without persistent ST segment elevation involves a rational, stepwise approach to the selection of
therapies with potential benefit for elderly patients. Specifically, in elderly patients with ACS without persistent ST segment elevation,
therapy should be administered based on the likelihood of
unstable angina or
non-ST elevation myocardial infarction being present and the risks and benefits of each individual
therapy. All elderly patients with suspected ACS should receive anti-ischaemic
therapy consisting of beta-blockers and
nitrates, and antiplatelet
therapy with
aspirin unless clear
contraindications exist. For patients with a moderate likelihood of ACS being present, defined as prior
coronary disease or recurrent
pain despite the use of anti-ischaemic
therapies,
unfractionated heparin or
enoxaparin should be added to
aspirin for more intense anticoagulation. In patients with high-risk clinical features, defined as ischaemic electrocardiographic changes and positive cardiac markers such as
troponins,
therapy with
clopidogrel or
glycoprotein IIb/IIIa inhibitors should be considered in addition to
aspirin and
heparin. Furthermore, high-risk patients should be managed with an early invasive strategy that includes prompt cardiac catheterisation within 24 to 48 hours and appropriate use of revascularisation as determined by the findings of the catheterisation. An evidence-based approach to the treatment of elderly patients with ACS without persistent ST segment elevation will help to improve the use of beneficial
therapies and interventions that are recommended by current practice guidelines.