2nd Cardiology Department, Hippokration Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Department of Cardiology, Essex Cardiothoracic Centre, Basildon, United Kingdom.
Curr Cardiol Rev. 2021;17(3):244-259. doi: 10.2174/1573403X16666200903153823.
Coronary artery disease (CAD) remains the leading cause of cardiovascular death in octogenarians. This group of patients represents nearly a fifth of all patients treated with percutaneous coronary intervention (PCI) in real-world practice. Octogenarians have multiple risk factors for CAD and often greater myocardial ischemia than younger counterparts, with a potential of an increased benefit from myocardial revascularization. Despite this, octogenarians are routinely under- -treated and belittled in clinical trials. Age does make a difference to PCI outcomes in older people, but it is never the sole arbiter of any clinical decision, whether in relation to the heart or any other aspect of health. The decision when to perform revascularization in elderly patients and especially in octogenarians is complex and should consider the patient on an individual basis, with clarification of the goals of the therapy and the relative risks and benefits of performing the procedure. In ST-segment elevation myocardial infarction (MI), there is no upper age limit regarding urgent reperfusion and primary PCI must be the standard of care. In non-ST-segment elevation acute coronary syndromes, a strict conservative strategy must be avoided; whereas the use of a routine invasive strategy may reduce the occurrence of MI and the need for revascularization at follow-up, with no established benefit in terms of mortality. In stable CAD patients, invasive therapy on top of optimal medical therapy seems better in symptom relief and quality of life. This review summarizes the available data on percutaneous revascularization in the elderly patients and particularly in octogenarians, including practical considerations on PCI risk secondary to ageing physiology. We also analyse technical difficulties met when considering PCI in this cohort and the ongoing need for further studies to ameliorate risk stratification and eventually outcomes in these challenging patients.
冠心病（CAD）仍然是 80 岁以上人群心血管死亡的主要原因。这组患者占真实世界经皮冠状动脉介入治疗（PCI）治疗患者的近五分之一。80 岁以上患者有多种 CAD 危险因素，通常比年轻患者有更大的心肌缺血，心肌血运重建的潜在获益更大。尽管如此，80 岁以上患者在临床试验中经常被治疗不足和轻视。年龄确实对老年人 PCI 结局有影响，但它绝不是任何临床决策的唯一裁决者，无论是与心脏还是与健康的任何其他方面有关。在老年患者，尤其是 80 岁以上患者中进行血运重建的决策是复杂的，应根据患者的个体情况考虑，明确治疗目标以及进行该手术的相对风险和获益。在 ST 段抬高型心肌梗死（MI）中，紧急再灌注没有年龄上限，必须采用直接 PCI 作为标准治疗。在非 ST 段抬高型急性冠脉综合征中，必须避免严格的保守策略；而常规采用侵入性策略可能会减少 MI 的发生和随访期间的血运重建需求，但在死亡率方面没有明确的获益。在稳定性 CAD 患者中，侵入性治疗联合最佳药物治疗似乎在缓解症状和提高生活质量方面更好。本综述总结了老年人，特别是 80 岁以上患者经皮血运重建的现有数据，包括与衰老生理相关的 PCI 风险的实际考虑。我们还分析了在这一年龄组中考虑 PCI 时遇到的技术困难，以及进一步研究改善这些具有挑战性患者的风险分层和最终结局的必要性。
