Percutaneous coronary intervention in nonagenarians: pros and cons

• Published in: Journal of geriatric cardiology : JGC Vol. 10; no. 1; pp. 82 - 90
• Main Authors: Biondi Zoccai, Giuseppe, Abbate, Antonio, D'Ascenzo, Fabrizio, Presutti, Davide, Peruzzi, Mariangela, Cavarretta, Elena, Marullo, Antonino G M, Lotrionte, Marzia, Frati, Giacomo
• Format: Journal Article
• Language: English
• Published: China Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy%VCU Pauley Heart Center, PO Box 980036, Richmond, VA 23298, USA%Divisione di Cardiologia, Università di Torino, Corso Bramante 88-90, 10126 Torino, Italy%Unità di Scompenso Cardiaco e Riabilitazione Cardiologica, Complesso Integrato Columbus, Via Moscati 31, 00168 Rome, Italy%Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy 01.03.2013; Department of AngioCardioNeurology, IRCCS Neuromed, Via Atinense 18, 86077 Pozzilli, Italy; Science Press
• Subjects: Review; Percutaneous coronary intervention; Coronary artery disease; Stent; Nonagenarian
• ISSN: 1671-5411
• DOI: 10.3969/j.issn.1671-5411.2013.01.013

Percutaneous coronary intervention is a mainstay in the management of symptomatic or high-risk coronary artery disease. The bulk of clinical evidence and experience underlying this fact relies, however, on relatively young patients. Indeed, few data of very limited quality are available which adequately define the risk-benefit and cost-benefit profile of coronary angioplasty and stenting in very old subjects, such as those of 90 years of age or older (i.e., nonagenarians). The aim of this review is to provide a concise, yet practical, synthesis of the available evidence on percutaneous coronary revascularization in the very elderly. The main arguments elaborated upon are to what extent we can extrapolate findings from studies including younger patients to nonagenarians, whether we should provide higher priority to prognosis or quality of life in such patients, and whether we can afford to allocate vast resources to care for such subjects in an era of financial constraints. Our review of 18 studies and 1082 patients suggest that percutaneous coronary intervention is feasible and associated with acceptable short- and long-term results in this population, which is nonetheless fraught with a high mortality risk irrespective of the revascularization procedure. Accordingly, the pros and cons of percutaneous coronary intervention should be carefully weighed when considering this treatment in nonagenarians.