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  • Review Article
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Percutaneous coronary intervention in the elderly

Nature Reviews Cardiology volume 8, pages 79–90 (2011)Cite this article

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Abstract

In contemporary practice, more than one in five patients treated with percutaneous coronary intervention (PCI) are aged ≥75 years and the proportion of elderly individuals in the population is growing. The elderly have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients needing PCI and, therefore, derive greater benefit from revascularization. However, they are also more likely to experience procedural complications, owing to age-related physiological changes, frailty, and comorbidities. This article reviews the outcomes of revascularization among the elderly and the impact of advances in PCI techniques and adjuvant pharmacotherapy on these outcomes. We also address clinical challenges that exist presently when considering PCI in the elderly, as well as future research needs to optimize revascularization outcomes in this population. To maximize the benefits of PCI in the elderly, providers should have explicit conversations with patients regarding goals of treatment. Once a decision to undergo PCI is reached, clinicians need to individualize care decisions, address modifiable risks such as bleeding, and pay careful attention to selection of the appropriate timing of PCI, and the type, timing, and dosing of adjuvant medical therapy.

Key Points

  • The population of patients treated with percutaneous coronary intervention in contemporary practice comprises a growing proportion of elderly patients

  • Age-related physiological changes augment both the potential benefit of coronary revascularization and the risk of procedure-related adverse outcomes

  • A broad range of antithrombin and antiplatelet agents is now available to minimize procedure-related thrombotic and bleeding risks in a patient-tailored fashion

  • A greater representation of elderly adults in clinical studies will not only improve our knowledge of this population, but also address age-related disparities in care

  • Functional outcomes are often more relevant to assess the effects of revascularization treatment than typical outcomes such as death or myocardial infarction

  • Novel, minimally invasive coronary revascularization techniques should be studied among the elderly, in whom they are likely to have the greatest applicability and benefit

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Figure 1
Figure 2: Trends in procedure-related mortality over time in patients undergoing elective percutaneous coronary intervention (2001–2006).
Figure 3: Adverse outcomes after percutaneous coronary intervention stratified by age and setting.
Figure 4: Outcomes associated with invasive and optimum medical therapy for coronary artery disease among patients aged >75 years.
Figure 5: Meta-analysis of 1-year survival rates in the elderly.

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References

  1. Alexander, K. P. et al. for the CRUSADE Investigators. Evolution in cardiovascular care for elderly patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative. J. Am. Coll. Cardiol. 46, 1479–1487 (2005).

    Article  PubMed  Google Scholar 

  2. Mehta, R. H. et al. Acute myocardial infarction in the elderly: differences by age. J. Am. Coll. Cardiol. 38, 736–741 (2001).

    Article  CAS  PubMed  Google Scholar 

  3. Anderson, J. L. et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. J. Am. Coll. Cardiol. 50, e1–e157 (2007).

    Article  PubMed  Google Scholar 

  4. Antman, E. M. et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, writing on behalf of the 2004 Writing Committee. Circulation 117, 296–329 (2008).

    Article  PubMed  Google Scholar 

  5. From, A. M., Rihal, C. S., Lennon, R. J., Holmes, D. R. Jr & Prasad, A. Temporal trends and improved outcomes of percutaneous coronary revascularization in nonagenarians. JACC Cardiovasc. Interv. 1, 692–698 (2008).

    Article  PubMed  Google Scholar 

  6. Singh, M. et al. Trends in the association between age and in-hospital mortality after percutaneous coronary intervention: National Cardiovascular Data Registry experience. Circ. Cardiovasc. Interv. 2, 20–26 (2009).

    Article  PubMed  Google Scholar 

  7. Bauer, T. et al. Predictors of hospital mortality in the elderly undergoing percutaneous coronary intervention for acute coronary syndromes and stable angina. Int. J. Cardiol. doi: 10.1016/j.ijcard.2010.05.006.

  8. Kelsey, S. F. et al. Results of percutaneous transluminal coronary angioplasty in patients ≥65 years of age (from the 1985 to 1986 National Heart, Lung, and Blood Institute's Coronary Angioplasty Registry). Am. J. Cardiol. 66, 1033–1038 (1990).

    Article  CAS  PubMed  Google Scholar 

  9. Rizo-Patron, C., Hamad, N., Paulus, R., Garcia, J. & Beard, E. Percutaneous transluminal coronary angioplasty in octogenarians with unstable coronary syndromes. Am. J. Cardiol. 66, 857–858 (1990).

    Article  CAS  PubMed  Google Scholar 

  10. Newman, A. B. et al. Coronary artery calcification in older adults to age 99: prevalence and risk factors. Circulation 104, 2679–2684 (2001).

    Article  CAS  PubMed  Google Scholar 

  11. Sangiorgi, G. et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J. Am. Coll. Cardiol. 31, 126–133 (1998).

    Article  CAS  PubMed  Google Scholar 

  12. Hsu, J. T., Kyo, E., Chu, C. M., Tsuji, T. & Watanabe, S. Impact of calcification length ratio on the intervention for chronic total occlusions. Int. J. Cardiol. doi: 10.1016/j.ijcard.2010.03.002.

  13. Soon, K. H. et al. CT coronary angiography predicts the outcome of percutaneous coronary intervention of chronic total occlusion. J. Interv. Cardiol. 20, 359–366 (2007).

    Article  PubMed  Google Scholar 

  14. De Felice, F. et al. Clinical outcome of patients with chronic total occlusion treated with drug-eluting stents. Int. J. Cardiol. 132, 337–341 (2009).

    Article  PubMed  Google Scholar 

  15. Hsu, J. T., Tamai, H., Kyo, E., Tsuji, T. & Watanabe, S. Traditional antegrade approach versus combined antegrade and retrograde approach in the percutaneous treatment of coronary chronic total occlusions. Catheter. Cardiovasc. Interv. 74, 555–563 (2009).

    Article  PubMed  Google Scholar 

  16. Batchelor, W. B. et al. Contemporary outcome trends in the elderly undergoing percutaneous coronary interventions: results in 7,472 octogenarians. J. Am. Coll. Cardiol. 36, 723–730 (2000).

    Article  CAS  PubMed  Google Scholar 

  17. Scheubel, R. J. et al. Age-dependent depression in circulating endothelial progenitor cells in patients undergoing coronary artery bypass grafting. J. Am. Coll. Cardiol. 42, 2073–2080 (2003).

    Article  PubMed  Google Scholar 

  18. Heiss, C. et al. Impaired progenitor cell activity in age-related endothelial dysfunction. J. Am. Coll. Cardiol. 45, 1441–1448 (2005).

    Article  CAS  PubMed  Google Scholar 

  19. Hill, J. M. et al. Circulating endothelial progenitor cells, vascular function, and cardiovascular risk. N. Engl. J. Med. 348, 593–600 (2003).

    Article  PubMed  Google Scholar 

  20. Becker, R. C. Thrombotic preparedness in aging: a translatable construct for thrombophilias? J. Thromb. Thrombolysis 24, 323–325 (2007).

    Article  PubMed  Google Scholar 

  21. Lopes, R. D. & Alexander, K. P. Antiplatelet therapy in older adults with non-ST-segment elevation acute coronary syndrome: considering risks and benefits. Am. J. Cardiol. 104 (Suppl. 5), 16C–21C (2009).

    Article  CAS  PubMed  Google Scholar 

  22. Balleisen, L., Bailey, J., Epping, P. H., Schulte, H. & van de Loo, J. Epidemiological study on factor VII, factor VIII and fibrinogen in an industrial population: I. Baseline data on the relation to age, gender, body-weight, smoking, alcohol, pill-using, and menopause. Thromb. Haemost. 54, 475–479 (1985).

    CAS  PubMed  Google Scholar 

  23. Mari, D. et al. Hypercoagulability in centenarians: the paradox of successful aging. Blood 85, 3144–3149 (1995).

    CAS  PubMed  Google Scholar 

  24. Zahavi, J., Jones, N. A., Leyton, J., Dubiel, M. & Kakkar, V. V. Enhanced in vivo platelet “release reaction” in old healthy individuals. Thromb. Res. 17, 329–336 (1980).

    Article  CAS  PubMed  Google Scholar 

  25. Terres, W., Weber, K., Kupper, W. & Bleifeld, W. Age, cardiovascular risk factors and coronary heart disease as determinants of platelet function in men. A multivariate approach. Thromb. Res. 62, 649–661 (1991).

    Article  CAS  PubMed  Google Scholar 

  26. Lakatta, E. G. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part III: cellular and molecular clues to heart and arterial aging. Circulation 107, 490–497 (2003).

    Article  PubMed  Google Scholar 

  27. Acree, L. S. et al. Age-related influences on markers of inflammation and fibrinolysis [abstract]. FASEB J. 22, 923.7 (2008).

  28. Knight, C. J. et al. Altered platelet function detected by flow cytometry. Effects of coronary artery disease and age. Arterioscler. Thromb. Vasc. Biol. 17, 2044–2053 (1997).

    Article  CAS  PubMed  Google Scholar 

  29. Vaughan, L., Zurlo, F. & Ravussin, E. Aging and energy expenditure. Am. J. Clin. Nutr. 53, 821–825 (1991).

    Article  CAS  PubMed  Google Scholar 

  30. Fülöp, T., Jr, Wórum, I., Csongor, J., Fóris, G. & Leövey, A. Body composition in elderly people. I. Determination of body composition by multiisotope method and the elimination kinetics of these isotopes in healthy elderly subjects. Gerontology 31, 6–14 (1985).

    Article  PubMed  Google Scholar 

  31. Robert, L. Aging of the vascular wall and atherogenesis: role of the elastin-laminin receptor. Atherosclerosis 123, 169–179 (1996).

    Article  CAS  PubMed  Google Scholar 

  32. Madhavan, S., Ooi, W. L., Cohen, H. & Alderman, M. H. Relation of pulse pressure and blood pressure reduction to the incidence of myocardial infarction. Hypertension 23, 395–401 (1994).

    Article  CAS  PubMed  Google Scholar 

  33. Vestal, R. E., Wood, A. J. & Shand, D. G. Reduced β-adrenoceptor sensitivity in the elderly. Clin. Pharmacol. Ther. 26, 181–186 (1979).

    Article  CAS  PubMed  Google Scholar 

  34. Haqqani, H. M. & Kalman, J. M. Aging and sinoatrial node dysfunction: musings on the not-so-funny side. Circulation 115, 1178–1179 (2007).

    Article  PubMed  Google Scholar 

  35. Reinecke, H. et al. Grade of chronic renal failure, and acute and long-term outcome after percutaneous coronary interventions. Kidney Int. 63, 696–701 (2003).

    Article  PubMed  Google Scholar 

  36. Mehran, R. et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J. Am. Coll. Cardiol. 44, 1393–1399 (2004).

    PubMed  Google Scholar 

  37. Fried, L. P. et al. Frailty in older adults: evidence for a phenotype. J. Gerontol. A Biol. Sci. Med. Sci. 56, M146–M156 (2001).

    Article  CAS  PubMed  Google Scholar 

  38. Buchner, D. M. & Wagner, E. H. Preventing frail health. Clin. Geriatr. Med. 8, 1–17 (1992).

    Article  CAS  PubMed  Google Scholar 

  39. Afilalo, J., Karunananthan, S., Eisenberg, M. J., Alexander, K. P. & Bergman, H. Role of frailty in patients with cardiovascular disease. Am. J. Cardiol. 103, 1616–1621 (2009).

    Article  PubMed  Google Scholar 

  40. Cohen, H. J. In search of the underlying mechanisms of frailty. J. Gerontol. A Biol. Sci. Med. Sci. 55, M706–M708 (2000).

    Article  CAS  PubMed  Google Scholar 

  41. Purser, J. L. et al. Identifying frailty in hospitalized older adults with significant coronary artery disease. J. Am. Geriatr. Soc. 54, 1674–1681 (2006).

    Article  PubMed  Google Scholar 

  42. Hlatky, M. A. et al. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am. J. Cardiol. 64, 651–654 (1989).

    Article  CAS  PubMed  Google Scholar 

  43. Working Group on Functional Outcome Measures for Clinical Trials. Functional outcomes for clinical trials in frail older persons: time to be moving. J. Gerontol. A Biol. Sci. Med. Sci. 63, 160–164 (2008).

  44. Guralnik, J. M. et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J. Gerontol. A Biol. Sci. Med. Sci. 55, M221–M231 (2000).

    Article  CAS  PubMed  Google Scholar 

  45. Walston, J. et al. for the Cardiovascular Health Study. Frailty and activation of the inflammation and coagulation systems with and without clinical comorbidities: results from the Cardiovascular Health Study. Arch. Intern. Med. 162, 2333–2341 (2002).

    Article  PubMed  Google Scholar 

  46. Penninx, B. W. et al. Anemia is associated with disability and decreased physical performance and muscle strength in the elderly. J. Am. Geriatr. Soc. 52, 719–724 (2004).

    Article  PubMed  Google Scholar 

  47. Subherwal, S. et al. Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) bleeding score. Circulation 119, 1873–1882 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  48. McKellar, S. H., Brown, M. L., Frye, R. L., Schaff, H. V. & Sundt, T. M. 3rd. Comparison of coronary revascularization procedures in octogenarians: a systematic review and meta-analysis. Nat. Clin. Pract. Cardiovasc. Med. 5, 738–746 (2008).

    Article  PubMed  Google Scholar 

  49. Johnman, C. et al. Percutaneous coronary intervention in the elderly: changes in case-mix and periprocedural outcomes in 31,758 patients treated between 2000 and 2007. Circ. Cardiovasc. Interv. 3, 341–345 (2010).

    Article  PubMed  Google Scholar 

  50. Giugliano, R. P., Lloyd-Jones, D. M., Camargo, C. A., Jr., Makary, M. A. & O'Donnell, C. J. Association of unstable angina guideline care with improved survival. Arch. Intern. Med. 160, 1775–1780 (2000).

    Article  CAS  PubMed  Google Scholar 

  51. Bhatt, D. L. et al. for the CRUSADE Investigators. Utilization of early invasive management strategies for high-risk patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE Quality Improvement Initiative. JAMA 292, 2096–2104 (2004).

    Article  CAS  PubMed  Google Scholar 

  52. Lakatta, E. G. Changes in cardiovascular function with aging. Eur. Heart J. 11 (Suppl. C), 22–29 (1990).

    Article  PubMed  Google Scholar 

  53. Lakatta, E. Aging effects on the vasculature in health: risk factors for cardiovascular disease. Am. J. Geriatr. Cardiol. 3, 11–17 (1994).

    PubMed  Google Scholar 

  54. Priebe, H. J. The aged cardiovascular risk patient. Br. J. Anaesth. 85, 763–778 (2000).

    Article  CAS  PubMed  Google Scholar 

  55. Folkow, B. & Svanborg, A. Physiology of cardiovascular aging. Physiol. Rev. 73, 725–764 (1993).

    Article  CAS  PubMed  Google Scholar 

  56. [No authors listed] Coronary Artery Surgery Study (CASS): a randomized trial of coronary artery bypass surgery. Quality of life in patients randomly assigned to treatment groups. Circulation 68, 951–960 (1983).

  57. [No authors listed] Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators. N. Engl. J. Med. 335, 217–225 (1996).

  58. Lee, P. Y., Alexander, K. P., Hammill, B. G., Pasquali, S. K. & Peterson, E. D. Representation of elderly persons and women in published randomized trials of acute coronary syndromes. JAMA 286, 708–713 (2001).

    Article  CAS  PubMed  Google Scholar 

  59. [No authors listed] A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Substudy Investigators. N. Engl. J. Med. 336, 1621–1628 (1997).

  60. de Boer, M. J. et al. for the Myocardial Infarction Study Group. Reperfusion therapy in elderly patients with acute myocardial infarction: a randomized comparison of primary angioplasty and thrombolytic therapy. J. Am. Coll. Cardiol. 39, 1723–1728 (2002).

    Article  PubMed  Google Scholar 

  61. Goldenberg, I. et al. Primary angioplasty with routine stenting compared with thrombolytic therapy in elderly patients with acute myocardial infarction. Am. Heart J. 145, 862–867 (2003).

    Article  PubMed  Google Scholar 

  62. Grines, C. L. SENIOR PAMI: a prospective randomized trial of primary angioplasty and thrombolytic therapy in elderly patients with acute myocardial infarction. Presented at the 17th Annual Transcatheter Cardiovascular Therapeutics Symposium, October 16–21, 2005.

  63. de Boer, S. P. et al. for the PCAT-2 Trialists Collaborators Group. Mortality and morbidity reduction by primary percutaneous coronary intervention is independent of the patient's age. JACC Cardiovasc. Interv. 3, 324–331 (2010).

    Article  PubMed  Google Scholar 

  64. Mehta, R. H. et al. for the GRACE Investigators. Effectiveness of primary percutaneous coronary intervention compared with that of thrombolytic therapy in elderly patients with acute myocardial infarction. Am. Heart J. 147, 253–259 (2004).

    Article  PubMed  Google Scholar 

  65. Tiefenbrunn, A. J., Chandra, N. C., French, W. J., Gore, J. M. & Rogers, W. J. Clinical experience with primary percutaneous transluminal coronary angioplasty compared with alteplase (recombinant tissue-type plasminogen activator) in patients with acute myocardial infarction: a report from the Second National Registry of Myocardial Infarction (NRMI-2). J. Am. Coll. Cardiol. 31, 1240–1245 (1998).

    Article  CAS  PubMed  Google Scholar 

  66. Thiemann, D. R. et al. Lack of benefit for intravenous thrombolysis in patients with myocardial infarction who are older than 75 years. Circulation 101, 2239–2246 (2000).

    Article  CAS  PubMed  Google Scholar 

  67. Antman, E. M. et al. The TIMI risk score for unstable angina/non-ST elevation MI: A method for prognostication and therapeutic decision making. JAMA 284, 835–842 (2000).

    Article  CAS  PubMed  Google Scholar 

  68. Eagle, K. A. et al. for the GRACE Investigators. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month postdischarge death in an international registry. JAMA 291, 2727–2733 (2004).

    Article  CAS  PubMed  Google Scholar 

  69. Bach, R. G. et al. The effect of routine, early invasive management on outcome for elderly patients with non-ST-segment elevation acute coronary syndromes. Ann. Intern. Med. 141, 186–195 (2004).

    Article  PubMed  Google Scholar 

  70. Gore, J. M. et al. Stroke after thrombolysis. Mortality and functional outcomes in the GUSTO-I trial. Global Use of Strategies to Open Occluded Coronary Arteries. Circulation 92, 2811–2818 (1995).

    Article  CAS  PubMed  Google Scholar 

  71. Boden, W. E. et al. for the COURAGE Trial Research Group. Optimal medical therapy with or without PCI for stable coronary disease. N. Engl. J. Med. 356, 1503–1516 (2007).

    Article  CAS  PubMed  Google Scholar 

  72. Shaw, L. J. et al. for the COURAGE Investigators. Optimal medical therapy with or without percutaneous coronary intervention to reduce ischemic burden: results from the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial nuclear substudy. Circulation 117, 1283–1291 (2008).

    Article  PubMed  Google Scholar 

  73. Weintraub, W. S. et al. for the COURAGE Trial Research Group. Effect of PCI on quality of life in patients with stable coronary disease. N. Engl. J. Med. 359, 677–687 (2008).

    Article  CAS  PubMed  Google Scholar 

  74. TIME Investigators. Trial of invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial. Lancet 358, 951–957 (2001).

  75. Pfisterer, M. et al. for the TIME Investigators. Outcome of elderly patients with chronic symptomatic coronary artery disease with an invasive vs optimized medical treatment strategy: one-year results of the randomized TIME trial. JAMA 289, 1117–1123 (2003).

    Article  PubMed  Google Scholar 

  76. Graham, M. M., Norris, C. M., Galbraith, P. D., Knudtson, M. L. & Ghali, W. A. for the APPROACH Investigators. Quality of life after coronary revascularization in the elderly. Eur. Heart J. 27, 1690–1698 (2006).

    Article  PubMed  Google Scholar 

  77. Singh, M. et al. Frailty and its potential relevance to cardiovascular care. Mayo Clin. Proc. 83, 1146–1153 (2008).

    Article  PubMed  Google Scholar 

  78. Aronow, W. S. & Fleg, J. (eds) Cardiovascular Disease in the Elderly 3rd edn (Marcel Dekker, New York, 2004).

    Google Scholar 

  79. Cheitlin, M. D. et al. Database Conference January 27–30, 2000, Washington DC—Do existing databases answer clinical questions about geriatric cardiovascular disease and stroke? Am. J. Geriatr. Cardiol. 10, 207–223 (2001).

    Article  CAS  PubMed  Google Scholar 

  80. Jin, R., Furnary, A. P., Fine, S. C., Blackstone, E. H. & Grunkemeier, G. L. Using Society of Thoracic Surgeons risk models for risk-adjusting cardiac surgery results. Ann. Thorac. Surg. 89, 677–682 (2010).

    Article  PubMed  Google Scholar 

  81. Wilson, M. F., Baig, M. K. & Ashraf, H. Quality of life in octagenarians after coronary artery bypass grafting. Am. J. Cardiol. 95, 761–764 (2005).

    Article  PubMed  Google Scholar 

  82. BARI Investigators. The final 10-year follow-up results from the BARI randomized trial. J. Am. Coll. Cardiol. 49, 1600–1606 (2007).

  83. Barsness, G. W. et al. Relationship between diabetes mellitus and long-term survival after coronary bypass and angioplasty. Circulation 96, 2551–2556 (1997).

    Article  CAS  PubMed  Google Scholar 

  84. Serruys, P. W. et al. Five-year outcomes after coronary stenting versus bypass surgery for the treatment of multivessel disease: the final analysis of the Arterial Revascularization Therapies Study (ARTS) randomized trial. J. Am. Coll. Cardiol. 46, 575–581 (2005).

    Article  PubMed  Google Scholar 

  85. Serruys, P. W. et al. for the ARTS II Investigators. 5-year clinical outcomes of the ARTS II (Arterial Revascularization Therapies Study II) of the sirolimus-eluting stent in the treatment of patients with multivessel de novo coronary artery lesions. J. Am. Coll. Cardiol. 55, 1093–1101 (2010).

    Article  PubMed  Google Scholar 

  86. Hlatky, M. A. et al. Coronary artery bypass surgery compared with percutaneous coronary interventions for multivessel disease: a collaborative analysis of individual patient data from ten randomised trials. Lancet 373, 1190–1197 (2009).

    Article  PubMed  Google Scholar 

  87. Artinian, N. T., Duggan, C. & Miller, P. Age differences in patient recovery patterns following coronary artery bypass surgery. Am. J. Crit. Care 2, 453–461 (1993).

    CAS  PubMed  Google Scholar 

  88. Peterson, E. D. et al. for the AHA Chronic CAD Working Group. Multicenter experience in revascularization of very elderly patients. Am. Heart J. 148, 486–492 (2004).

    Article  PubMed  Google Scholar 

  89. Newman, M. F. et al. for the Neurological Outcome Research Group and the Cardiothoracic Anesthesiology Research Endeavors Investigators. Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. N. Engl. J. Med. 344, 395–402 (2001).

    Article  CAS  PubMed  Google Scholar 

  90. Slater, J. P. et al. Cerebral oxygen desaturation predicts cognitive decline and longer hospital stay after cardiac surgery. Ann. Thorac. Surg. 87, 36–44 (2009).

    Article  PubMed  Google Scholar 

  91. Shroyer, A. L. et al. for the ROOBY Study Group. On-pump versus off-pump coronary-artery bypass surgery. N. Engl. J. Med. 361, 1827–1837 (2009).

    Article  CAS  PubMed  Google Scholar 

  92. Kaehler, J., Meinertz, T. & Hamm, C. W. Coronary interventions in the elderly. Heart 92, 1167–1171 (2006).

    Article  PubMed  PubMed Central  Google Scholar 

  93. PROTECT I, A Prospective Feasibility Trial Investigating the Use of IMPELLA RECOVER LP 2.5 System in Patients Undergoing High Risk PCI. Clinical trials.gov [online], (2010).

  94. Arieti, M., Pesarini, G. & Ribichini, F. Percutaneous Impella Recover circulatory support in high-risk coronary angioplasty. Cardiovasc. Revasc. Med. 9, 269–274 (2008).

    Article  PubMed  Google Scholar 

  95. Hybrid Revascularization Observational Study. Clinical trials.gov [online], (2010).

  96. Groeneveld, P. W., Matta, M. A., Greenhut, A. P. & Yang, F. Drug-eluting compared with bare-metal coronary stents among elderly patients. J. Am. Coll. Cardiol. 51, 2017–2024 (2008).

    Article  CAS  PubMed  Google Scholar 

  97. Douglas, P. S. et al. Clinical effectiveness of coronary stents in elderly persons: results from 262,700 Medicare patients in the American College of Cardiology–National Cardiovascular Data Registry. J. Am. Coll. Cardiol. 53, 1629–1641 (2009).

    Article  PubMed  PubMed Central  Google Scholar 

  98. ESPRIT Investigators. Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial. Lancet 356, 2037–2044 (2000).

  99. Boersma, E. et al. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials. Lancet 359, 189–198 (2002).

    Article  CAS  PubMed  Google Scholar 

  100. Hoekstra, J. W. et al. Early glycoprotein IIb/IIIa inhibitor use for non-ST-segment elevation acute coronary syndrome: patient selection and associated treatment patterns. Acad. Emerg. Med. 12, 431–438 (2005).

    Article  PubMed  Google Scholar 

  101. Sadeghi, H. M. et al. Percutaneous coronary interventions in octogenarians: glycoprotein IIb/IIIa receptor inhibitors' safety profile. J. Am. Coll. Cardiol. 42, 428–432 (2003).

    Article  CAS  PubMed  Google Scholar 

  102. Yang, X. et al. for the CRUSADE Investigators. The implications of blood transfusions for patients with non-ST-segment elevation acute coronary syndromes: results from the CRUSADE National Quality Improvement Initiative. J. Am. Coll. Cardiol. 46, 1490–1495 (2005).

    Article  PubMed  Google Scholar 

  103. Alexander, K. P. et al. for the CRUSADE Investigators. Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes. JAMA 294, 3108–3116 (2005).

    Article  CAS  PubMed  Google Scholar 

  104. Alexander, K. P. et al. Decline in GP 2b3a inhibitor overdosing with site-specific feedback in CRUSADE [abstract 3527]. Circulation 116 (Suppl. II), 798–799 (2007).

    Google Scholar 

  105. Lincoff, A. M. et al. for the REPLACE-2 Investigators. Long-term efficacy of bivalirudin and provisional glycoprotein IIb/IIIa blockade vs heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary revascularization: REPLACE-2 randomized trial. JAMA 292, 696–703 (2004).

    Article  CAS  PubMed  Google Scholar 

  106. Lopes, R. D. et al. Advanced age, antithrombotic strategy, and bleeding in non-ST-segment elevation acute coronary syndromes: results from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J. Am. Coll. Cardiol. 53, 1021–1030 (2009).

    Article  CAS  PubMed  Google Scholar 

  107. Lopes, R. D. et al. Antithrombotic strategy in non-ST-segment elevation myocardial infarction patients undergoing percutaneous coronary intervention: insights from the ACTION (Acute Coronary Treatment and Intervention Outcomes Network) Registry. JACC Cardiovasc. Interv. 3, 669–677 (2010).

    Article  PubMed  Google Scholar 

  108. Marso, S. P. et al. Association between use of bleeding avoidance strategies and risk of periprocedural bleeding among patients undergoing percutaneous coronary intervention. JAMA 303, 2156–2164 (2010).

    Article  CAS  PubMed  Google Scholar 

  109. Mehta, S. R. et al. for the CURE Investigators. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet 358, 527–533 (2001).

    Article  CAS  PubMed  Google Scholar 

  110. Steinhubl, S. R. et al. Early and sustained dual oral antiplatelet therapy following percutaneous coronary intervention, a randomized controlled trial (CREDO). JAMA 288, 2411–2420 (2002).

    Article  CAS  PubMed  Google Scholar 

  111. Berger, P. B. et al. for the CHARISMA Investigators. Bleeding complications with dual antiplatelet therapy among patients with stable vascular disease or risk factors for vascular disease: results from the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management, and Avoidance (CHARISMA) trial. Circulation 121, 2575–2583 (2010).

    Article  CAS  PubMed  Google Scholar 

  112. Wiviott, S. D. et al. for the TRITON-TIMI 38 Investigators. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N. Engl. J. Med. 357, 2001–2015 (2007).

    Article  CAS  PubMed  Google Scholar 

  113. Chin, C. T. et al. for the TRILOGY ACS Steering Committee. Study design and rationale of a comparison of prasugrel and clopidogrel in medically managed patients with unstable angina/non-ST-segment elevation myocardial infarction: the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial. Am. Heart J. 160, 16–22.e11 (2010).

    Article  CAS  PubMed  Google Scholar 

  114. Wallentin, L. et al. for the PLATO Investigators. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N. Engl. J. Med. 361, 1045–1057 (2009).

    Article  CAS  PubMed  Google Scholar 

  115. Leonardi, S. et al. Rationale and design of the randomized, double-blind trial testing INtraveNous and Oral administration of elinogrel, a selective and reversible P2Y12-receptor inhibitor, versus clopidogrel to eVAluate Tolerability and Efficacy in nonurgent Percutaneous Coronary Interventions patients (INNOVATE-PCI). Am. Heart J. 160, 65–72 (2010).

    Article  CAS  PubMed  Google Scholar 

  116. Mehta, S. K. et al. Bleeding in patients undergoing percutaneous coronary intervention: the development of a clinical risk algorithm from the National Cardiovascular Data Registry. Circ. Cardiovasc. Interv. 2, 222–229 (2009).

    Article  PubMed  Google Scholar 

  117. Thrombocyte Activity Reassessment and GEnoTyping for PCI (TARGET-PCI). Clinical trials.gov [online], (2010).

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Acknowledgements

C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the MedscapeCME-accredited continuing medical education activity associated with this article.

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  1. Duke Clinical Research Institute, 2400 Pratt Street, Durham, 27705, NC, USA

    Tracy Y. Wang, Antonio Gutierrez & Eric D. Peterson

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T. Y. Wang, A. Gutierrez, and E. D. Peterson contributed to discussion of content for the article, researched data to include in the manuscript, reviewed and edited the manuscript before submission, and revised the manuscript in response to the peer-reviewers' comments.

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Correspondence to Eric D. Peterson.

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Competing interests

T. Y. Wang declares that she has received grants/research support from the following companies: Bristol-Myers Squibb, Canyon, Daiichi Sankyo, Eli Lilly, Heartscape Technologies, Merck, Sanofi-Aventis, Schering Plough, and Stacks. T. Y. Wang also declares that she has been a consultant for the following companies: Heartscape Technologies and Medco Health Solutions. E. D. Peterson declares that he has received grants/research support from the following companies: Bristol-Myers Squibb, Daiichi Sankyo, Eli Lilly, Johnson & Johnson, Merck, Sanofi-Aventis, and Schering Plough. A. Gutierrez declares no competing interests.

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Wang, T., Gutierrez, A. & Peterson, E. Percutaneous coronary intervention in the elderly. Nat Rev Cardiol 8, 79–90 (2011). https://doi.org/10.1038/nrcardio.2010.184

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