Acute Coronary Syndrome in Octogenarians: Expect the Unexpected

Chest pain is a common presenting symptom for ACS, but elderly patients with MI are more likely to present with other chief complaints. Only 40% of patients in the National Registry of Myocardial Infarction database ≥ 85 years of age had chest pain on initial presentation. Recent studies comparing invasive therapy (PCI or coronary artery bypass graft) with optimal medical therapy for patients > 75 years of age diagnosed with NSTEMI have reported a reduced risk of death and major cardiac events with invasive therapy. Emergency physicians should have a high level of suspicion for ACS in octogenarians, even in those presenting without chest pain. Timely diagnosis and management can improve morbidity and mortality in these patients.