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Arisha et al. Vessel Plus 2018;2:14 Vessel Plus
DOI: 10.20517/2574-1209.2018.29

Review Open Access

Percutaneous coronary intervention in the elderly:
current updates and trends

Mohammed J. Arisha , Dina A. Ibrahim , Ahmed A. Abouarab , Mohamed Rahouma , Mohamed K. Kamel ,
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Massimo Baudo , Kritika Mehta , Mario F. L. Gaudino
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1 Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
2 Department of Medicine, Brown University, Providence, RI 01912, USA.
3 Department of Cardiothoracic Surgery, Weill Cornell/New York Presbyterian Hospital, New York, NY 10065, USA.
Correspondence to: Dr. Mario F. L. Gaudino, Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th St.,
Suite M 404, New York, NY 10065, USA. E-mail: mfg9004@med.cornell.edu
How to cite this article: Arisha MJ, Ibrahim DA, Abouarab AA, Rahouma M, Kamel MK, Baudo M, Mehta K, Gaudino MFL.
Percutaneous coronary intervention in the elderly: current updates and trends. Vessel Plus 2018;2:14.
http://dx.doi.org/10.20517/2574-1209.2018.29
Received: 8 May 2018 Accepted: 5 Jul 2018 Published: 9 Jul 2018

Science Editors: Aaron S. Dumont, Alexander D. Verin Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
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. The rate of growth of the older segment of the population has increased
exponentially and will become more pronounced in the future. 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. 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. There are several
factors that make interventional cardiologists more resistant to direct the elderly to PCI. Most of these challenging
factors, such as the complexity of coronary lesions, frailty, hematological and vascular changes, are discussed in this
review. In addition. 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. Several recent studies have shown better results when these
strategies are adopted. The most recent recommendations regarding performing PCI in the elderly are also discussed in
this review.

Keywords: Percutaneous coronary intervention, coronary artery disease, acute coronary syndrome, coronary stents,
angioplasty, elderly, old age patients, frail patients, high risk patients

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

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