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

Abstract

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 et al 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.

Keywords: Frailty; Non-ST elevation myocardial infarction; Percutaneous coronary intervention; Personalised care

Core Tip: Frailty is increasingly recognized as a key determinant of outcomes in elderly patients with non-ST elevation myocardial infarction, yet its role in guiding invasive management remains debated. The recent analysis by Popat et al suggests that percutaneous coronary intervention may confer survival benefit across frailty categories, while also exposing patients to higher risks of complications, longer hospitalizations, and greater costs. These findings highlight the complexity of decision-making in this vulnerable cohort. In this letter to the editor, we reflect on these results and discuss them in the context of current literature, practice guidelines, and future directions.