Sameer Satija, MD, Clinical Fellow, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
Nanette K. Wenger, MD, Professor of Medicine (Cardiology), Emory University School of Medicine, Atlanta; Chief of Cardiology, Grady Memorial Hospital, Atlanta, GA, USA.
Chronic angina is a common problem among older adults. The burden of coronary heart disease in patients over age 75 is high. Coronary angiography, percutaneous coronary intervention with or without stenting, and coronary artery bypass graft surgery all entail higher risk in the older population. Nevertheless, patients older than 75 also may accrue a greater benefit, given their increased risk for overall cardiac mortality. We suggest a measured approach to revascularization in older adults with chronic angina, considering their severity of symptoms, the adequacy of treatment of angina, their left ventricular ejection fraction, patient preference, other comorbidities, and ischemic burden identified by noninvasive testing.
Key words: angina, revascularization, older adults, coronary disease, coronary angiography.