高齢者虚血性心疾患の治療の考え方

Abstract

Clinical features of ischemic heart disease in the elderly are different from those in non-elderly patients. The prevalence of female patients, hypertension and co-morbidity was higher in the elderly than in non-elderly patients. Atypical clinical presentation should be taken into consideration, particularly in patients with acute coronary syndrome, because early initiation of coronary reperfusion therapy reduces mortality significantly in elderly patients. In chronic stable angina, risk stratification of patients using stress myocardial perfusion imaging plays an important clinical role. The management of coronary risk factors to prevent cardiovascular events is of utmost importance in the elderly since the mortality of acute myocardial infarction is very high. Among classical risk factors, beneficial effects of the management of blood pressure on hypertensive and/or diabetic patients are enormous. Recent development of percutaneous coronary intervention facilitated coronary revascularization to reduce ischemic burden even in patients aged 80 years or older due to the low invasiveness of the procedure. However, cardiac surgery is still regarded as the first option for the elderly ith associated aortic stenosis, diffuse 3-vessel coronary artery disease, or distal left main trunk disease.