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Updated: Jun 6, 2026
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Percutaneous coronary intervention in the elderly
Tracy Y Wang1, Antonio Gutierrez, Eric D Peterson
1Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC 27705, USA.
Insights
Percutaneous coronary intervention (PCI) offers significant benefits for elderly patients with ischemic heart disease. Optimizing PCI outcomes in older adults requires individualized care, addressing bleeding risks, and careful medication management.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Growing proportion of elderly patients (≥75 years) undergoing percutaneous coronary intervention (PCI).
- Elderly patients have higher cardiovascular risk and ischemic disease burden, yet face increased procedural complication risks.
- Age-related physiological changes, frailty, and comorbidities contribute to increased risks in older adults.
Purpose of the Study:
- To review revascularization outcomes in elderly patients undergoing PCI.
- To assess the impact of advancements in PCI techniques and pharmacotherapy on elderly patient outcomes.
- To address current clinical challenges and identify future research needs for optimizing PCI in this population.
Main Methods:
- Review of contemporary practices and outcomes of percutaneous coronary intervention in patients aged ≥75 years.
- Analysis of the influence of evolving PCI techniques and adjuvant pharmacotherapy on treatment efficacy and safety.
- Discussion of clinical decision-making processes, risk factor management, and therapeutic strategies for elderly PCI candidates.
Main Results:
- Elderly patients derive substantial benefit from PCI due to greater ischemic disease burden.
- Advancements in PCI techniques and pharmacotherapy have improved outcomes but challenges remain.
- Increased risk of procedural complications is associated with age-related factors and comorbidities.
Conclusions:
- Maximizing PCI benefits in the elderly necessitates explicit patient-provider discussions on treatment goals.
- Individualized care, including managing bleeding risks and optimizing medical therapy timing and dosing, is crucial.
- Further research is needed to refine PCI strategies and improve long-term outcomes for older adults.
Abstract:
In contemporary practice, more than one in five patients treated with percutaneous coronary intervention (PCI) are aged ≥75 years and the proportion of elderly individuals in the population is growing. The elderly have more cardiovascular risk factors and a greater burden of ischemic disease than younger patients needing PCI and, therefore, derive greater benefit from revascularization. However, they are also more likely to experience procedural complications, owing to age-related physiological changes, frailty, and comorbidities. This article reviews the outcomes of revascularization among the elderly and the impact of advances in PCI techniques and adjuvant pharmacotherapy on these outcomes. We also address clinical challenges that exist presently when considering PCI in the elderly, as well as future research needs to optimize revascularization outcomes in this population. To maximize the benefits of PCI in the elderly, providers should have explicit conversations with patients regarding goals of treatment. Once a decision to undergo PCI is reached, clinicians need to individualize care decisions, address modifiable risks such as bleeding, and pay careful attention to selection of the appropriate timing of PCI, and the type, timing, and dosing of adjuvant medical therapy.
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