It is controversial whether to take aggressive interventional or conservative treatment in elderly ACS patients. 2012 Transcatheter Interventional Therapy (TCT) conference reported a review of 1001 ACS patients (555 NSTEMI, 213 STEMI) with a mean age of (81±5) years, 776 were treated with interventional therapy and 224 with conservative therapy, these patients had a combination of chronic obstructive Pulmonary disease, previous PCI, previous coronary artery bypass grafting (CABG), peripheral vascular disease, stroke, renal insufficiency, diabetes mellitus, hypertension, hyperlipidemia, obesity, and GRACE score for risk stratification was performed in both groups, showing that mortality during hospitalization was significantly lower in the interventional group compared to the conservative group (3.5% versus 15.6%, P<0.001), and total complications in both groups There was no difference in total complications between the two groups. Cumulative mortality was found to be better in both STEMI and NSTEMI than in the conservative treatment group using bivariate regression analysis, and GRACE score, renal insufficiency, Killip classification >2, diabetes, previous PCI, age, obesity, COPD, and previous stroke were found to be predictors of long-term mortality using univariate analysis. Therefore, in elderly patients with ACS (>75 years) given a direct PCI strategy after assessment of the above risk factors, age is not a deciding factor for conservative or invasive treatment. Gao Lijian, Department of Cardiovascular Medicine, Fu Wai Hospital, Beijing, China