Modern approaches to diagnosis of acute coronary syndrome in elderly and senile patients

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Abstract

Population aging is a global trend, and by 2050, the proportion of people over 65 years old is expected to be approximately 16 % of the world’s population. In the Kyrgyz Republic, the number of elderly people has increased by 24 % over the past five years, leading to an increase in the prevalence of cardiovascular diseases. Acute coronary syndrome (ACS) remains one of the leading causes of morbidity and mortality in the elderly. Since this category of patients often exhibits atypical clinical manifestations, multimorbidity, and cognitive and functional impairment, this significantly complicates diagnosis and management. This article presents current data on the diagnosis of ACS in elderly patients. Particular attention is paid to the complexity of interpreting complaints and anamnestic data, physical examination, and the specifics of electrocardiogram analysis, where age-related changes and comorbidities often mask ischemic manifestations. The role of high-sensitivity troponin, the standard for diagnosing myocardial injury, is discussed. However, in the elderly, its prognostic value is reduced due to frequent elevations associated with chronic diseases. The capabilities of noninvasive and invasive imaging methods – echocardiography, cardiac magnetic resonance imaging, coronary computed tomography angiography, as well as intracoronary methods such as intravascular ultrasound and optical coherence tomography allowing for a more precise diagnosis and treatment strategy are discussed in detail. It is emphasized that no single imaging method offers sufficient diagnostic accuracy in elderly patients. Therefore, the optimal strategy should be a personalized approach based on a multidisciplinary assessment that takes into account cognitive and functional status, comorbidities, geriatric syndromes, and social factors. This approach improves the timeliness of diagnosis and the effectiveness of medical care, ensuring more favorable outcomes in elderly and senile patients with ACS.

About the authors

Zulfiia T. Radzhapova

1st President of the Russian Federation B. N. Yeltsin Kyrgyz-Russian Slavic University

Author for correspondence.
Email: mztzmr@gmail.com
ORCID iD: 0000-0002-8255-0473
Kyrgyzstan, 44 Kievskaya St., Bishkek 720000

T. M. Murataliev

I.K. Akhunbaev Kyrgyz State Medical Academy; Mirsaid Mirrakhimov National Center of Cardiology and Internal Medicine, Ministry of Health of Kyrgyz Republic

Email: murataliev@mail.ru
ORCID iD: 0000-0003-2281-8199
Kyrgyzstan, 92 Akhunbaevа St., Bishkek 720020; 3 T. Moldo St., Bishkek 720040

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Copyright (c) 2026 Radzhapova Z.T., Murataliev T.M.

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