Risk Stratification in Elderly Coronary Artery Disease Patients: Can We Predict Which Seniors Benefit Most from Revascularization Options?

Abstract

With the increased global burden of an aging population manifesting cardiovascular disease, the decision process for use of coronary revascularization options in older adults has gained attention. Assessment of physiologic status has greater bearing than chronologic age; items that have proven of particular merit in evaluating comorbidities as they relate to treatment prognosis for both PCI and CABG in older adults include EuroSCORE and frailty scoring. Evaluation of neurocognitive function can uncover the presence and severity of all-cause dementia, which may be missed in simple medical history interaction. These data have significance when considering aggressive coronary artery disease treatments in this population for symptomatic and/or survival benefit, particularly when high priority is placed on quality of life and independent living post-treatment. Recovery after procedural intervention is slower and with increased morbidity in older adults. Older adults tend to have more complex coronary artery disease; for some, the risk/benefit of revascularization may be prohibitive. Proper selection by the cardiac team for appropriateness of treatment options for each patient’s circumstances can result in excellent percutaneous coronary intervention and coronary artery bypass graft revascularization outcomes, even in the older adult.