According to the World Health Organization, the number of people aged 60 years and older is rapidly increasing. While in 2019, 1 billion people were older than 60 years, it is expected that this number will increase to 1.4 billion by 2030 and 2.1 billion by 2050 [ ]. Over a lifetime, coronary risk factors accumulate as parallelly increases the susceptibility to suffer from an acute coronary syndrome (ACS). In older adults, prognosis of an ACS is worse than in their younger counterparts. Increased atherosclerosis plaque burden with prevalence of coronary calcification and the coexistence of age-related comorbid conditions contribute to this impaired prognosis [ ]. In the randomized EXAMINATION trial, patients with ST segment elevation myocardial infarction (STEMI) aged >75 years presented a rate of cardiac death 10 times higher than that of patients aged <55 years during the 10-year follow-up [ ]. Typically, older adults present with higher risk of bleeding, contrast-induced nephropathy, vascular access-site related complications, and may express some degree of cognitive impairment and/or frailty [ ]. In this context, invasive approach is often restricted and limited to patients with apparent better conditions which may represent a form of ageism [ , ].