Functional Outcomes in Elderly Patients With Acute Coronary Syndrome: Conservative Versus Invasive Management

Introduction: In developing countries, cardiovascular disease is a major health burden, and there has been a rapid increase in the incidence of acute coronary syndrome (ACS) in the elderly population. Despite this, there are only limited studies or data available regarding the outcomes of ACS in elderly patients. Hence, this study focused on the management of ACS in the elderly treated conservatively and invasively. Materials and methods: This longitudinal study was conducted at a tertiary care center in Kerala, India, involving 64 geriatric patients (aged 60 years and above) newly diagnosed with ACS. Subjects were recruited via convenience sampling and divided equally into invasive (percutaneous coronary intervention (PCI)/coronary artery bypass grafting (CABG); n = 32) and non-invasive/conservative treatment (n = 32) groups. Functional status was evaluated at initial admission, one month, and six months using the validated 7-item Seattle Angina Questionnaire (SAQ-7), which evaluates physical limitation, angina frequency, quality of life, and summary scores. Results: At six months of follow-up, invasively treated patients had significantly better functional status in all domains compared to non-invasive patients (p = 0.001 for all domains). Systemic hypertension was present in 37 patients and was significantly associated with a poorer functional status summary score at six months (p = 0.001). No significant clear associations were noted for diabetes mellitus or dyslipidemia with a functional decline. Conclusion: Geriatric patients presenting with ACS achieve substantially better functional capacity, reduced angina frequency, and superior health-related quality of life when managed with an invasive strategy compared to a conservative approach. Systemic hypertension acts as an independent risk factor for functional status decline.