Percutaneous coronary intervention in the elderly

- The elderly population is increasing but surprisingly there are only a small number of studies looking at percutaneous coronary interventions in the elderly
- The elderly tend to have more tortuous and calcified coronary and peripheral arteries, greater coronary disease burden, number of coexisting comorbidities, and higher MACE
- Elderly patients often present with atypical or fewer symptoms
- Elderly patients admitted with STE-ACS or NSTE-ACS generally have a better prognosis when treated with percutaneous coronary intervention than those treated medically.
- Elderly patients need to be assessed by a multidisciplinary team if appropriate to allow risk stratification to identify those most to gain by intervention.

Our population dynamics are changing. The number of octogenarians and older people in the general population is increasing and therefore the number of older patients presenting with acute coronary syndrome or stable angina is increasing. This group has a larger burden of coronary disease and also a greater number of concomitant comorbidities when compared to younger patients. Many of the studies assessing percutaneous coronary intervention (PCI) to date have actively excluded octogenarians. However, a number of studies, both retrospective and prospective, are now being undertaken to reflect the, “real” population. Despite being a higher risk group for both elective and emergency PCIs, octogenarians have the greatest to gain in terms of prognosis, symptomatic relief, and arguably more importantly, quality of life. Important future development will include assessment of patient frailty, encouraging early presentation, addressing gender differences on treatment strategies, identification of culprit lesion(s) and vascular access to minimise vascular complications. We are now appreciating that the new frontier is perhaps recognising and risk stratifying those elderly patients who have the most to gain from PCI. This review article summarises the most relevant trials and studies.