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Type: Journal article
Title: An overview of PCI in the very elderly
Author: Shanmugam, V.
Harper, R.
Meredith, I.
Malaiapan, Y.
Psaltis, P.
Citation: Journal of Geriatric Cardiology, 2015; 12(2):174-184
Publisher: Science Press
Issue Date: 2015
ISSN: 1671-5411
Statement of
Vimalraj Bogana Shanmugam, Richard Harper, Ian Meredith, Yuvaraj Malaiapan, Peter J Psaltis
Abstract: Cardiovascular disease, and in particular ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly (> 80 years) worldwide. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting that they have greater scope of benefit from coronary revascularization therapy. Despite this, the very elderly are frequently under-represented in clinical revascularization trials and historically there has been a degree of physician reluctance in referring them for PCI procedures, with perceptions of disappointing outcomes, low success and high complication rates. Several issues have contributed to this, including the tendency for older patients with IHD to present late, with atypical symptoms or non-diagnostic ECGs, and reservations regarding their procedural risk-to-benefit ratio, due to shorter life expectancy, presence of comorbidities and increased bleeding risk from antiplatelet and anticoagulation medications. However, advances in PCI technology and techniques over the past decade have led to better outcomes and lower risk of complications and the existing body of evidence now indicates that the very elderly actually derive more relative benefit from PCI than younger populations. Importantly, this applies to all PCI settings: elective, urgent and emergency. This review discusses the role of PCI in the very elderly presenting with chronic stable IHD, non ST-elevation acute coronary syndrome, and ST-elevation myocardial infarction. It also addresses the clinical challenges met when considering PCI in this cohort and the ongoing need for research and development to further improve outcomes in these challenging patients.
Keywords: Acute coronary syndrome; angina; antithrombotic therapy; myocardial infarction; octogenarians; percutaneous coronary intervention; the elderly
Rights: ©2015 JGC All rights reserved.
RMID: 0030063175
DOI: 10.11909/j.issn.1671-5411.2015.02.012
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Appears in Collections:Medicine publications

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