Percutaneous Coronary Intervention in Elders: Less is More

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Percutaneous Coronary Intervention in Elders
Less is More

• Joseph C. Cleveland, Jr., MD
• Associate Professor of Surgery
• Surgical Director, Cardiac Transplantation and
  MCS
• University of Colorado at Denver

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CVD is Age Related
Prevalence of CVD in adults age 20 and older by
age and sex (NHANES 2005-2006). Source NCHS and
NHLBI. These data include coronary heart
disease, heart failure, stroke and hypertension.
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PCI versus CAB Debate

• Elderly vastly underrepresented in all randomized
  controlled trials
• Moving target because of changes in
  percutaneous techniques
• Definition of multivessel disease
• Outcomes/follow-up relatively short

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Circulation 2002 1052378-84
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Benefits of Aggressive Revascularization
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Evidence Based Medicine RCT for PCI v CAB
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PCI versus CAB Debate

• Would you rather have your chest split wide open
  like a chicken or have your problem taken care of
  with a tiny needle hole in the leg?
• We can fix this problem right here today or you
  can have your chest opened like a can or sardines
  to fix this problem

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American Heart Journal 20041481089
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American Heart Journal 20041481089
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PCI vs. CAB Outcomes Elderly
American Heart Journal 20041481089
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Mortality after Intervention as Function of Age
American Heart Journal 20041481089
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Conclusions

• Coronary Artery Disease increases with Age
• Revascularization should be offered to elders
  the bang is greatest for the buck
• Percutaneous techniques offer lower mortality
  risk than coronary artery bypass grafting
• Questions that need to be addressed relate to
  functional outcomes and quality of life

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