Acute coronary syndrome in the elderly: assessment, diagnosis and treatment.

Síndrome coronario agudo en el anciano: evaluación, diagnóstico y tratamiento.

Introduction: The coronary diseases, especially the acute coronary syndromes, gather a group of entities that  lead to high mortality rates among older patients, who represent a very important population in epidemiological terms, given their characteristic  diagnostic and therapeutic difficulties, which can be explained by the poor amount of studies and a low representation at clinical trials, thus generating great doubts in daily clinical practice. Objective: To describe the most updated and relevant aspects in acute coronary syndrome in the old patient, emphasizing in the diagnostic process and its variations, and therapeutic considerations based on last available scientific evidence. Methodology: A systematic review of literature about acute coronary syndrome in the old patient published in last 20 years, from 1996 to 2016 was performed, in data bases Pubmed and Embase during December 2015 and January 2016. Articles in English and Spanish were included. The studies were excluded based on abstracts assessment. Conclusion: The old patients represent a very highly heterogeneous group which presents multiple physiological cardiovascular changes, generating important variations in symptomatology of acute coronary syndrome. Their representation among different clinical trials remains being poor, which turns very difficult making decisions in clinical practice. More studies are required in order to achieve the most optimal management in the old patient.