[Interventional therapy indications in the elderly - are they different?]

The prevalance of cardiovascular disease increases with age and cardiovascular disease is the leading cause of death in adults >75 years of age. However many trials have excluded older patients. So we don't have randomized trials but only limited subgroup analysis or registries for older patients. In general the indications for intervention and revascularization are not different in elderly patients. But complex co-morbidities, significant physical or cognitive disabilities can change our decision. Complex Coronary anatomy and the complications of the procedure is high in older patients. Long term mortality is similar in patients treated with Coronary artery bypass graft surgery or percutaneous coronary intervention, but re-intervention is higher in coronary intervention group. Invazive approach is superior to conservative treatment even in very elderly patients with acute coronary syndrome. We need randomized trials including mainly older patients in this era.