Surgical management of coronary arterial disease in the elderly
1Department of Surgery, University of California at Irvine, USA.
Insights
Coronary revascularization in the elderly prolongs life and improves quality of life. Earlier detection and elective surgery for coronary artery disease (CAD) in older adults can reduce mortality and disability.
Area of Science:
- Cardiology
- Geriatric Medicine
- Vascular Surgery
Background:
- Coronary artery disease (CAD) is increasingly prevalent in patients over 65.
- CAD in the elderly often presents atypically, leading to delayed diagnosis.
- Coronary revascularization procedures are increasing in octogenarians and nonagenarians.
Purpose of the Study:
- To evaluate the role and outcomes of coronary artery angioplasty and bypass in the elderly.
- To discuss the justification for performing revascularization procedures in older patients.
- To explore strategies for improving outcomes in elderly patients with CAD.
Main Methods:
- Review of current practices and outcomes for coronary revascularization in elderly patients.
- Analysis of diagnostic challenges and treatment approaches for CAD in older adults.
- Discussion of cost-effectiveness and quality-of-life implications.
Main Results:
- Coronary revascularization in the elderly can significantly prolong life and enhance quality of life.
- Delayed diagnosis and emergency procedures in the elderly increase operative mortality and costs.
- Atypical presentation of CAD in older adults contributes to diagnostic delays.
Conclusions:
- Early detection and elective coronary revascularization can improve outcomes for elderly patients with CAD.
- Increased efforts in identifying ischemic heart disease in this population are warranted.
- Despite challenges, revascularization offers benefits over alternative treatments for elderly patients.
Abstract:
Coronary artery angioplasty or bypass is being performed for increasing numbers of patients in their seventh, eighth, ninth and even tenth decades of life. Because of the cost involved, justification for performing these procedures in the elderly has become a topic of daily discussion among those responsible for funding healthcare. Both silent and overt coronary artery disease (CAD) are more common in the population over 65 years of age. Because CAD in the elderly often presents in an atypical manner, diagnosis of the disease is frequently delayed. Partly because of the delayed diagnosis and partly because of cost considerations, coronary arterial bypass (CABG) is more often performed as an emergency procedure in the elderly with the results that both operative mortality and costs are increased over those observed in a younger population. Nevertheless, it is clear that performance of coronary revascularization procedures in the elderly can both prolong life and improve the quality of life beyond what can be achieved using alternative methods of treatment. Greater efforts directed toward detection of ischemic heart disease in the these patients and earlier, elective surgery could significantly reduce both the mortality and disability associated with CAD in the elderly.
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