Assessment and Management of Older Adults Undergoing PCI, Part 1
Michael G. Nanna, Nadia R. Sutton, Ajar Kochar, Jennifer A. Rymer, Angela Lowenstern, Grace Gackenbach, Scott L. Hummel, Parag Goyal, Michael W. Rich, James N. Kirkpatrick, Ashok Krishnaswami, Karen P. Alexander, Daniel E. Forman, Anna E. Bortnick, Wayne Batchelor, Abdulla A. Damluji
Abstract
As the population ages, older adults represent an increasing proportion of patients referred to the cardiac catheterization laboratory. Older adults are the highest-risk group for morbidity and mortality, particularly after complex, high-risk percutaneous coronary interventions. Structured risk assessment plays a key role in differentiating patients who are likely to derive net benefit vs those who have disproportionate risks for harm. Conventional risk assessment tools from national cardiovascular societies typically rely on 3 pillars: 1) cardiovascular risk; 2) physiologic and hemodynamic risk; and 3) anatomic and procedural risks. We propose adding a fourth pillar: geriatric syndromes, as geriatric domains can supersede all other aspects of risk.