We thank Dr Jelinek for his comments and wish to clarify a few important points. First, optimal treatment must be carefully individualized. Medical decision making is complex, and accurate risk stratification is only the first step. Withholding aggressive treatment from high-risk patients with ACS may be entirely appropriate under certain circumstances (eg, terminal illness, patient's wishes). Dr Jelinek argues that “the concentration on more intensive treatment for younger patients may be more appropriate than ignorant.” Although age is a marker of comorbidities, age alone should not be the sole determinant of treatment. While there are other crucial management considerations (eg, cost-effectiveness, expected gain in life expectancy and quality of life), they are beyond risk stratification and should not in the least detract from its importance.
Yan AT, Yan RT, Goodman SG. Is Concentration on More Intensive Treatment for Younger Patients More Rational and Humane Than Ignorant?—Reply. Arch Intern Med. 2009;169(15):1442-1443. doi:10.1001/archinternmed.2009.242