Читать книгу Practical Cardiovascular Medicine - Elias B. Hanna - Страница 46

Patients > 75 years old with ACS have double the mortality of younger patients. Elderly patients more frequently have atypical presentations with milder ST changes. While associated with a higher major bleeding risk in patients > 75 years old, an early invasive strategy drastically reduced the absolute risk of death/MI by 10% at 6 months in those inherently high-risk patients (TACTICS-TIMI-18 trial).¹³⁶ This was further confirmed in a trial that randomized octogenarian ACS patients to an invasive vs. conservative strategy, using predominantly a radial access (AFTER EIGHTY).¹³⁷ However, this benefit may only apply to carefully selected elderly patients with limited comorbidities and bleeding risk, similar to the patients recruited in clinical trials. A careful access (radial) and antithrombotic strategy may maximize the benefit from an invasive strategy, and GPI should be avoided if possible.