Assessment and Management of Older Adults Undergoing PCI, Part 1: A JACC: Advances Expert Panel

Area of Science:

• Geriatric medicine
• Cardiology
• Interventional cardiology

Background:

• Aging population increases referrals to cardiac catheterization labs.
• Older adults have the highest risk of morbidity and mortality, especially after high-risk percutaneous coronary interventions.
• Current risk assessment tools may not adequately capture risks in this demographic.

Purpose of the Study:

• To highlight the importance of geriatric syndromes in risk assessment for older adults undergoing cardiac catheterization.
• To propose an expanded risk assessment framework incorporating geriatric domains.

Main Methods:

• Review of current risk assessment strategies for cardiac catheterization.
• Identification of key geriatric syndromes relevant to cardiovascular procedures.
• Proposal of a four-pillar risk assessment model.

Main Results:

• Conventional risk assessment relies on cardiovascular, physiologic, hemodynamic, and anatomic/procedural factors.
• Geriatric syndromes represent a critical, often overlooked, domain of risk in older adults.
• These syndromes can significantly influence outcomes and may supersede other risk factors.

Conclusions:

• A comprehensive risk assessment for older adults undergoing cardiac catheterization must include geriatric syndromes.
• Integrating geriatric assessments can improve patient selection and optimize outcomes.
• This expanded approach aims to ensure net benefit by accounting for unique geriatric vulnerabilities.