A metaanalysis of 6 RCTs about the use of GP IIb/IIIa inhibitors in patients with NSTE-ACS reported no significant age-treatment interaction, although older women had signifi- cantly more adverse events.549 Bivalirudin appears safer for older patients with NSTE-ACS PCI than GP IIb/IIIa inhibi- tors plus UFH, with less bleeding and similar efficacy.526,550 AF is more common in older patients with NSTE-ACS, and triple therapy (DAPT and warfarin) entails a marked bleeding In the WOEST (What is the Optimal Antiplatelet and Anticoagulant Therapy in Patients With Oral Anticoagulation and Coronary Stenting) study, it was found that in patients taking oral coagulants who required PCI, use of clopidogrel without aspirin was associated with a significant reduction in bleeding complications and no increase in thrombotic Nonetheless, practice should not be changed on the basis of this limited study alone. Older patients with NSTE-ACS benefit as much or more than younger patients from an early invasive strategy com- pared with an ischemia-guided strategy.340,341,515,518,519 In a 5-year follow-up meta-analysis of FRISC-II and RITA-3, an early invasive strategy versus an ischemia-guided strategy was associated with a significant reduction in death/MI and MI in patients 75 years of age but not in patients <65 years Although the highest risk reduction in death/MI with an early invasive strategy occurred in those 75 years of age, this strategy was associated with a 3-fold bleeding risk.552 However, despite the overall favorable evidence for an early invasive strategy in older patients, age is the strongest risk fac- tor for this group not undergoing an early invasive strategy.553 PCI has increased in older patients, including the very elderly ( 90 years of age), with success rates similar to younger patients and declining complication rates, including Several large registries report a greater RR reduction in mortality of older patients treated with revascularization versus medical therapy compared with those 65 years of age, despite increased comorbidities.517,540,554 556 Operative mortality rates for CABG in patients 80 years of age with NSTE-ACS range from 5% to 8% (11% for urgent cases) and increase to approximately 13% at 90 years of age. 