Comment on “Clinical outcome of older adults developing acute coronary syndrome during hospitalization for noncardiac illness”

To the Editor, We read with great interest the article by David et al. entitled “Clinical outcome of older adults developing acute coronary syndrome during hospitalization for noncardiac illness” (J Curr Cardiol 2025; 3:58-64). The authors address an under-recognized yet clinically important condition – acute coronary events emerging during noncardiac admissions in older adults. While their observations are valuable, several methodological and interpretative points merit further discussion. First, the study provides a descriptive comparison between patients admitted primarily with acute coronary syndrome (ACS) and those developing ACS secondarily during hospitalization. However, critical geriatric dimensions – frailty and multimorbidity indices such as the Clinical Frailty Scale (CFS), Charlson Comorbidity Index (CCI), and Cumulative Illness Rating Scale for Geriatrics (CIRS-G) – were not incorporated. These validated tools are crucial in elderly cardiac populations, as they predict prognosis, treatment tolerance, and clinical decision-making. Moreover, the study did not include validated prognostic indicators such as the Global Registry of Acute Coronary Events (GRACE) score, which is widely recommended in international guidelines as a reliable predictor of both short- and long-term mortality in ACS, particularly among older and comorbid patients. The absence of these frailty-comorbidity scales and the GRACE score limits the interpretation of whether the high mortality and suboptimal treatment observed were due to disease burden or frailty-related therapeutic restrictions, and weakens the study’s clinical applicability. Second, the definition of “acute coronary syndrome” appears to include heterogeneous entities, likely encompassing type 2 myocardial infarction or isolated myocardial injury in patients with sepsis, anemia, or renal dysfunction. Differentiating these conditions, in accordance with the Fourth Universal Definition of Myocardial Infarction (2018), would enhance diagnostic precision and guide management strategies more accurately. Finally, incorporating multivariable analyses that include frailty and GRACE scores could identify independent predictors of mortality and provide actionable insights for clinicians. The 6-month survival rate of only 57.4% in this cohort underscores the importance of such models. We commend the authors for addressing an important and often neglected topic and encourage future studies to integrate comprehensive geriatric and cardiologic assessment frameworks (CFS, CCI, CIRS-G, and GRACE) when evaluating ACS among hospitalized older adults. This combined approach would allow a more accurate assessment of mortality risk, treatment appropriateness, and individualized care strategies. Sincerely, Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.