Elderly patients represent a growing proportion of the acute coronary syndrome population in Western countries. However, their frequent atypical symptoms at presentation often lead to delays in management and to misdiagnosis. Furthermore, their prognosis is poorer than that of younger patients because of physiological changes in platelet function, haemostasis and fibrinolysis, but also a higher proportion of comorbidities and frailty, both of which increase the risk of recurrent thrombotic and bleeding events. This complex situation, with ischaemic and haemorrhagic risk factors often being intertwined, may lead to confusion about the required treatment strategy, sometimes resulting in inadequate management or even to therapeutic nihilism. It is therefore critical to provide a comprehensive overview of our understanding of the pathophysiological processes underlying acute coronary syndrome in elderly patients, and to summarise the results from the latest clinical trials to help decision making for these high-risk patients.

在西方国家，老年患者占急性冠状动脉综合症人口的比例越来越高。但是，他们经常出现的非典型症状常常导致治疗延迟和误诊。此外，由于血小板功能，止血和纤维蛋白溶解的生理变化，而且其合并症和虚弱的比例更高，它们的预后比年轻患者差，这两者都增加了复发性血栓和出血事件的风险。这种复杂的情况经常伴随着缺血性和出血性危险因素交织在一起，可能导致对所需治疗策略的困惑，有时导致管理不善甚至导致治疗虚无。