[Clinical specificities of coronary artery disease in the elderly].

Unstable angina and acute coronary syndromes (ACS) without ST-segment elevation are frequent in the elderly and is associated to a very poor prognosis. The cause of mortality excess in the elderly has not yet been fully elucidated, even though the numerous comorbidities present in this age range play a non-negligible role. In every case, age is the most powerful prognostic factor for ACS without ST-segment elevation. The presentation and clinical characteristics of coronary disease in the elderly are particular and are essential to be recognized. Patients are mostly women with history of heart failure and myocardial infarction, and risk factors are predominantly diabetes and hypertension. The usual presentation is a "silent" MI or with atypical symptoms. Instead of typical chest pain, the coronary artery disease will be presented by dyspnea, neurological symptoms such as confusion, cognitive disorders aggravation, digestive disorders. This atypical presentation will have direct consequences on the therapeutic management of ACS, and sometimes it will even remain undiagnosed, and these explain also why complications will be more severe than in younger counterparts. Due to this atypical presentation, the physician should be careful and suspect an ACS in case of any non-explicated modification of physical and behavioral change in the elderly.