elderly will be the fastest growing part of the population in Western countries and aged individuals constitute a rapidly increasing proportion of patients presenting with acute coronary syndromes (ACS) including ST-elevation myocardial infarction (STEMI). of these patients at initial presentation. Symptoms following acute coronary occlusion are less specific electrocardiographic patterns more often not the typical pattern of ST-segment elevation and confounding morbidity may all contribute to diagnostic uncertainty and delayed or ‘conservative’ decision-making. In this issue of the Netherlands Heart Journal Claessen et al. attempt to fill in the gaps inside our understanding GSK2118436A by an in depth description of the cohort of 196 individuals aged ≥?80 years within the 2002 individuals treated with major angioplasty for STEMI in the Academic INFIRMARY Amsterdam between 1 January 2003 and 31 July 2008 [1]. At 3-yr follow-up mortality as well as the occurrence of both bleeding and ischaemic events were tightly related to to age. Having a 3-yr mortality of ±?40?% reinfarction in ±?23?% bleeding in 1/3 of individuals and heart stroke in 1/12 of individuals ≥?80 years it really is clear that there surely is a large prospect of improvement which is certainly appropriate to provide this issue a far more prominent put on our scientific agenda. Nevertheless before getting into the collection and explanation of even more registry data or even while the authors recommend an ardent randomised managed trial we ought to consider some problems to put these results in perspective. Individual selection To become one of them cohort older people STEMI patient got to attain the cathlab plus they needed to survive the principal angioplasty procedure. Inside a paper KSHV ORF62 antibody entitled ‘Changing developments in and features connected with NOT going through cardiac catheterisation in seniors GSK2118436A adults hospitalised with ST-segment elevation severe myocardial infarction’ Tisminetzky describe the 10 years long (1999-2009) developments in the pace of NOT going through angiography and angioplasty as well as the factors connected with not really going through these procedures within an observational population-based research in the establishing of Worchester Massachusetts [2]. Old adults who develop STEMI are significantly likely to go through cardiac catheterisation and angioplasty but many high-risk groups frequently still usually do not make it to the cathlab including ladies people with prior infarction and the ones with different comorbidities. From a human population perspective outcomes will tend GSK2118436A to be substantially worse weighed against the individuals described from the AMC researchers. If individuals make it to the cathlab are we performing better? In a written report through the Swedish coronary angiography and angioplasty registry (SCAAR) Velders et al. explain 4876 elderly STEMI individuals [3]. Procedural prognoses and success of the individuals >? 80 years remained similar throughout a 10-year period despite changes in individual treatment and characteristics. The good thing of this record can be that although advanced age group strongly increased the chance of adverse occasions survivors of the first phase got a somewhat improved prognosis weighed against the general human population. Nevertheless this may also be interpreted as further evidence for patient selection undertreatment and bias. Bleeding complications Gain access to site related aswell as non-access related bleeding includes a negative effect on standard of living and relates to brief- and long-term prognosis. Specifically gastrointestinal bleeding relates to several risk elements including age group and the usage of triple antithrombotic therapy (dental anticoagulation + dual antiplatelet therapy) and it is a strong independent predictor of all-cause mortality at 1 year [4]. Implications The authors conclude that ‘especially in this high-risk individual group individualised therapy is required to optimise clinical results’. We will GSK2118436A attempt to become more particular. Presentation: We ought to remember that severe coronary occlusion in seniors individuals often leads to ‘atypical’ medical presentations specifically in ladies and how the level of sensitivity and specificity from the electrocardiographic adjustments in these individuals are modest producing a threat of underdiagnosis. Decision-making: Although ischaemic period is important in a few STEMI individuals in older people the impact of the 30 and even 60 minute hold off is very moderate and even.