Frailty in elderly patients with non-ST elevation myocardial infarction: Balancing the risks and benefits of percutaneous coronary intervention

Frailty has emerged as a critical determinant of clinical outcomes in cardiovascular patients undergoing invasive management. Although percutaneous coronary intervention (PCI) remains the cornerstone of therapy for acute coronary syndromes, its role in elderly and frail patients with non-ST elevation myocardial infarction (NSTEMI) continues to raise uncertainty. Recent evidence underscores the complex interplay between survival benefit, procedural risk, and healthcare utilization in this vulnerable population. In this context, Popat <i>et al</i> applied the hospital frailty risk score to stratify outcomes in elderly patients (≥ 75 years) undergoing PCI. Their analysis provides valuable insights into the prognostic significance of frailty assessment and its potential role in guiding individualized treatment decisions. In this letter to the editor, we reflect on these findings and discuss them in relation to current literature, practice guidelines, and future directions for managing frail elderly patients with NSTEMI.