Acute Coronary Syndrome Management in Older Patients: A Dual-Center Retrospective Cohort Study.

: Older patients with ACS are less frequently treated with an invasive strategy, which may negatively impact their survival. This study aimed to investigate treatment approaches in elderly ACS patients and compare outcomes between invasively and conservatively treated groups. : This retrospective study included consecutive patients aged 80 or older who presented with ACS at two tertiary institutions from November 2018 to October 2023. The invasive group consisted of patients who underwent percutaneous or surgical revascularization. The conservative strategy was defined as guideline-directed medical therapy only. The primary outcome was all-cause mortality during the six-month follow-up. Secondary outcomes were recurrent MI and CVI. : Among 670 ACS patients with a median age of 83 years (81-86) and 50.6% women, 429 (64%) were treated with an invasive strategy, and 241 (36%) were treated with a conservative strategy. A total of 176 (26%) patients died during the six-month follow-up period, with significantly higher mortality observed in the conservatively treated group compared to the invasively treated group (ACS: 37.8% vs. 19.3%, < 0.001; STEMI: 49.4% vs. 26.8%, < 0.001; NSTE-ACS: 32.1% vs. 10.9%, < 0.001). Recurrent MI was documented in 2.5% of patients, while CVI occurred in 1.2%, with no difference between the treatment groups. Multivariable regression analysis identified invasive strategy (HR = 0.48; 95% CI: 0.33-0.71; < 0.001) as a positive predictor of six-month survival in ACS patients. : The invasive treatment strategy was associated with lower mortality in older ACS patients, regardless of the type of ACS. The incidence of recurrent MI and CVI did not differ between groups treated with different therapeutic approaches.