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 need for revascularization at follow-up, with no established benefit in terms of mortality. In stable CAD patients,
invasive therapy on top of the 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.
Late primary angioplasty (beyond 12 h): are we sure it should be avoided?
