Background: Age is a determining prognostic factor after acute coronary syndrome (ACS). The aim of our study was to describe the clinical aspects of elderly coronary patients, to assess our management and to assess their short- and long-term prognosis.

Methods: We conducted a descriptive retrospective study including all patients aged 75 years and over hospitalized for ACS with ST elevation (STEMI) or without ST elevation (NSTE-ACS) in the cardiology department of the university hospital of Sfax during the period from January 1, 2018 to December 31, 2019

Results: We included 158 patients. The mean age was 79.78 years old. The sex ratio (M / F) was 1.82. The main cardiovascular risk factors were hypertension (73.4%) followed by diabetes (46.8%). The mean Charlson's Index was 3.72. Anemia was observed in 35.4% of patients. An atypical presentation is noted in 21.4% of patients. The mean time from onset of symptoms to diagnosis was 13.15 hours in the STEMI group and 115.94 hours in the NSTE-ACS- group. Coronary angiography was performed in 40.6% of NSTE-ACS and primary angioplasty in 67.4% of STEMI. Complete revascularization was obtained in 32.6% of NSTE-ACS and 51.5% of STEMI. Complications observed during hospitalization were stent thrombosis (2.27%) bleeding (7%) and contrast induced nephropathy (36.7%). Mortality was 2.5% during hospitalization and 7.1% long-term during a mean follow-up of 23.58 months.

Conclusion: ACS in the elderly poses a diagnostic problem because of the frequency of atypical symptoms, and therapeutic problem because of the fragility of these patients with frequent comorbidities, sources of bleeding complications and less use of an invasive strategy.