[Acute coronary syndrome in the elderly. Optimal revascularisation strategies].

Although there are accepted guidelines for treatment of acute coronary syndromes and ST-segment elevation myocardial infarction, elderly patients may have a variety of conditions that can complicate the decision making process about the best therapy. For fear of adverse effects many elderly patients do not receive potentially lifesaving treatments, such as percutaneous coronary intervention or thrombolytic therapy. Appropriate revascularisation therapy also often will be received too late in the course of the infarct, when irreversible myocardial damage has occurred. Many studies, however, show that older patients will benefit substantially from these therapies and early treatment improves outcome in this population, despite a higher risk of complications. In this review, the evidence regarding medical and revascularisation therapies in acute coronary syndromes in the elderly is critically examined.