Elderly patients with non-ST-segment elevation myocardial infarction (NSTEMI) face substantially higher risk when treated non-invasively. These findings were presented at European Society of Cardiology (ESC) Congress 2025, emphasizing the importance of tailored approaches for older adults with acute coronary syndrome.

The SPUM registry included 4,787 ACS patients across four Swiss university hospitals. Among 2,239 NSTEMI patients, 203 (9%) received conservative management without coronary angiography. These patients were older, had more hypertension and diabetes, and exhibited a higher prevalence of prior cardiovascular events, heart failure, and impaired renal function.

At one year, MACE occurred in 19.2% of conservatively treated patients versus 10.1% of invasively treated patients. Among patients aged ≥75 years, MACE risk rose to 33.9% and remained significantly elevated after adjusting for baseline characteristics (HR 3.12, 95% CI 1.49–6.66).

These data suggest that non-invasive strategies in elderly NSTEMI patients may lead to suboptimal outcomes. AI-supported risk stratification could guide personalized treatment and improve cardiovascular prognosis in this high-risk group.