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Lookup NU author(s): Dr Greg Mills, Dr Graziella Pompei, Professor Vijay KunadianORCiD
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND).
© 2025 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Introduction: Invasive management of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) should be considered regardless of age, but a key challenge is deciding which patients are most likely to benefit from an invasive approach in the older population. In addition to assessment of the clinical signs and symptoms, a holistic assessment of geriatric syndromes such as frailty, multimorbidity and cognitive impairment is of increasing importance. Recent trials have validated the roles of physiological assessment and intracoronary imaging to guide revascularisation. Areas covered: This review focuses on the comparison between invasive and conservative management in the older population with NSTE-ACS, the clinical characteristics of the older population with NSTE-ACS, and the role of physiological assessment and intracoronary imaging to guide revascularisation in this cohort. Expert opinion: Invasive management in the older population with NSTE-ACS may not improve mortality but reduces the risk of non-fatal myocardial infarction and repeat revascularisation. Decisions surrounding invasive versus conservative management should be individualized to each patient, depending on patient preference, clinical features, comorbidities and frailty. In patients where invasive management is indicated, a combination of physiological assessment and intracoronary imaging is likely to improve revascularisation outcomes, especially in the context of complex anatomical characteristics like multivessel disease.
Author(s): Gill K, Mills GB, Wang W, Pompei G, Kunadian V
Publication type: Review
Publication status: Published
Journal: Expert Review of Cardiovascular Therapy
Year: 2025
Volume: 23
Issue: 3
Pages: 73-86
Online publication date: 12/03/2025
Acceptance date: 28/02/2025
ISSN (print): 1477-9072
ISSN (electronic): 1744-8344
Publisher: Taylor and Francis Ltd.
URL: https://doi.org/10.1080/14779072.2025.2476125
DOI: 10.1080/14779072.2025.2476125
PubMed id: 40056095
