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Acute coronary syndromes
Coronary revascularisation in the elderly
  1. James Cockburn,
  2. David Hildick-Smith,
  3. Uday Trivedi,
  4. Adam de Belder
  1. Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
  1. Correspondence to Dr James Cockburn, Sussex Cardiac Centre, Brighton and Sussex University Hospitals NHS Trust, Brighton BN2 5BE, UK; james.cockburn{at}, jacockburn{at}

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Leaning objectives

  • Factors to consider that influence decision-making in octogenarians being considered for revascularisation.

  • Evidence base for revascularisation strategies for symptomatic stable octogenarians.

  • Evidence base for revascularisation strategies in unstable (acute coronary syndromes) octogenarians.


To date, there remains no universal definition for ‘elderly’, and indeed for some, biological age does not correspond with chronological age. However, most now consider elderly as those aged ≥80 years.

Within the Western world, the general population is ageing; therefore, the proportion of octogenarians (defined as age >80 years) in the general population is expected to triple by the year 2050.1

Advanced age is associated with an increased incidence of coronary heart disease, with patients presenting with both stable and unstable (acute coronary syndromes (ACS)) symptoms.2 ,3 Hence, cardiovascular disease is a leading cause of morbidity and mortality in older people, and increasingly, elderly patients are referred for revascularisation. As such, they represent an important high-risk subgroup of patients. Myocardial revascularisation is appropriate when the expected benefits, in terms of survival or health outcomes (symptoms, functional status and/or quality of life (QoL)), exceed the expected negative consequences of the procedure.4

However, revascularisation in this high-risk population is not without risk. It can often be a very difficult clinical decision whether or not an elderly patient should undergo attempted revascularisation, irrespective of the modality, whether that be by coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI). Many have significant comorbid pathology, and previous studies have shown that octogenarians experience increased in-hospital complications and mortality relative to younger patients.3 ,5

To date, many revascularisation trials have focused on a younger patient demographic, with octogenarians often under-represented, and with varying definitions. Therefore, the existing evidence and guidelines that exist are often extrapolated from trial based on a younger patient population into this rapidly growing …

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  • Contributors All authors contributed to the article and were involved with the planning and layout of the work. JC prepared and wrote the article, and is responsible for the overall content. DHS, AdB and UT offered critical appraisal of the manuscript.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

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