Frailty,one of the most common geriatric syndromes,is associated with the increase of mortality and re-hospitalization in older patients with acute coronary syndrome(ACS).Older patients with debilitating ACS often have many co-morbidities,which puts clinicians in a"dilemma"and complicates therapeutic decision-making.However,there is currently no expert consensus or guideline for the diagnosis and treatment.This article summarizes recent studies to provide evidence for the management of these patients.