[Which elderly with stable angina should be referred for cardiac surgery?]

Area of Science:

• Cardiology
• Geriatric Medicine
• Interventional Cardiology

Background:

• Coronary revascularization decisions are complex in elderly patients (80 years and over).
• Current guidelines lack specific randomized data for this demographic.
• Registries suggest surgical benefits but with higher risks.

Observation:

• Four clinical cases of elective coronary artery bypass grafting (CABG) or percutaneous coronary transluminal angioplasty (PTCA) in patients aged 80+ are presented.
• Coronary lesions in the elderly are often more complex, typically favoring surgical intervention.
• Co-morbidities, surgical risk, cognitive function, and patient frailty complicate revascularization choices.

Findings:

• No dedicated randomized studies exist for elderly patients undergoing revascularization.
• Existing data indicate superior medium- and long-term benefits for surgery over PTCA, despite increased mortality and stroke risks.
• Frailty, a subjective measure, is correlated with mortality and requires consideration.

Implications:

• Revascularization decisions must balance mortality and morbidity risks, including potential decline in general condition and autonomy.
• Further randomized trials are crucial to address the specificities of aging subjects.
• Incorporating frailty assessment into treatment guidelines is essential for optimizing elderly patient care.