Despite the recent advancements that have been achieved in both clinical and interventional cardiology realms, the management of coronary artery disease (CAD) in the elderly is still a major concern, both for cardiac interventionists and surgeons. Octogenarians and older populations constituted a smaller segment of only 3.7% comparing to their younger counterparts in 2012 but it is also expected to jump up to 3.9% and 5.4% by 20, respectively. In 1970, the population aged 65 years and older constituted only 9.8% of the total population in the United States, however, in 2012 it increased to 13.7% and it is expected to exceed 20% by the year 2030. For many reasons, the rate of growth has increased exponentially and will become more pronounced in the future, especially in the developed world. The elderly group of population has grown substantially. It is considered the leading cause of death with acute coronary syndrome (ACS) accounting for more than 30% of causes of mortality in the elderly population (aged 65 years or older).
Ischemic heart disease is one of the major challenges that encounter healthcare providers all over the world. The most recent recommendations regarding performing PCI in the elderly are also discussed in this review. Several recent studies have shown better results when these strategies are adopted. more advanced technologies have been introduced to PCI platform such as second- and third-generations stents, several alternative approaches have been adopted like transradial approach and the usage of bivalirudin instead of heparin and GP IIb/IIIa inhibitor, and several imaging modalities have been optimized to assess patients’ outcome and prognosis more accurately. Most of these challenging factors, such as the complexity of coronary lesions, frailty, hematological and vascular changes, are discussed in this review. There are several factors that make interventional cardiologists more resistant to direct the elderly to PCI. However, the safety, efficacy, and outcomes of PCI in the older population have started to receive more attention, leading to some changes in their trends. Historically, there has been a paucity of clinical trials investigating the challenges and outcomes of more invasive treatment strategies such as percutaneous coronary intervention (PCI) for that very segment of the population. The rate of growth of the older segment of the population has increased exponentially and will become more pronounced in the future. Ischemic heart disease is the leading cause of death with acute coronary syndrome accounting for more than 30% of causes of mortality in the elderly population.
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