Assessment and Management of Older Adults Undergoing PCI, Part 1: A JACC: Advances Expert Panel

Michael G Nanna¹, Nadia R Sutton^{2

3}, Ajar Kochar⁴, Jennifer A Rymer⁵, Angela M Lowenstern⁶, Grace Gackenbach⁷, Scott L Hummel⁸, Parag Goyal⁹, Michael W Rich¹⁰, James N Kirkpatrick¹¹, Ashok Krishnaswami¹², Karen P Alexander⁵, Daniel E Forman^{13

14}, Anna E Bortnick¹⁵, Wayne Batchelor¹⁶, Abdulla A Damluji^{16

17}

Affiliations

¹ Yale University School of Medicine, New Haven, Connecticut, USA.
² Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
³ Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, and Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.
⁴ Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Duke University School of Medicine, Durham, North Carolina, USA.
⁶ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁷ University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
⁸ University of Michigan School of Medicine and VA Ann Arbor Health System, Ann Arbor, Michigan, USA.
⁹ Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
¹⁰ Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
¹¹ Division of Cardiology, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA.
¹² Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California, USA.
¹³ Divisions of Geriatrics and Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁴ VA Pittsburgh GRECC, Pittsburgh, Pennsylvania, USA.
¹⁵ Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
¹⁶ Inova Center of Outcomes Research, Fairfax, Virginia, USA.
¹⁷ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

PMID: 37584013
PMCID: PMC10426754
DOI: 10.1016/j.jacadv.2023.100389

Assessment and Management of Older Adults Undergoing PCI, Part 1: A JACC: Advances Expert Panel

Michael G Nanna et al. JACC Adv. 2023 Jun.

. 2023 Jun;2(4):100389.

doi: 10.1016/j.jacadv.2023.100389.

Authors

Affiliations

¹ Yale University School of Medicine, New Haven, Connecticut, USA.
² Department of Internal Medicine, Division of Cardiovascular Medicine, Michigan Medicine, Ann Arbor, Michigan, USA.
³ Department of Internal Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, and Department of Biomedical Engineering, Vanderbilt University, Nashville, Tennessee, USA.
⁴ Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
⁵ Duke University School of Medicine, Durham, North Carolina, USA.
⁶ Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁷ University of Michigan School of Medicine, Ann Arbor, Michigan, USA.
⁸ University of Michigan School of Medicine and VA Ann Arbor Health System, Ann Arbor, Michigan, USA.
⁹ Department of Medicine, Weill Cornell Medicine, New York, New York, USA.
¹⁰ Division of Cardiology, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA.
¹¹ Division of Cardiology, Department of Bioethics and Humanities, University of Washington School of Medicine, Seattle, Washington, USA.
¹² Division of Cardiology, Kaiser Permanente San Jose Medical Center, San Jose, California, USA.
¹³ Divisions of Geriatrics and Cardiology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
¹⁴ VA Pittsburgh GRECC, Pittsburgh, Pennsylvania, USA.
¹⁵ Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
¹⁶ Inova Center of Outcomes Research, Fairfax, Virginia, USA.
¹⁷ Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

PMID: 37584013
PMCID: PMC10426754
DOI: 10.1016/j.jacadv.2023.100389

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.

Keywords: acute coronary syndrome; cardiac catheterization; cardiovascular disease; geriatric assessment; multimorbidity; older adults; percutaneous coronary intervention; polypharmacy.

PubMed Disclaimer

Conflict of interest statement

Dr Nanna consults for HeartFlow, Inc. Dr Rymer has relationships with Chiesi, Abiomed, Pfizer, and Idorsia. Dr Lowenstern is a consultant for Edwards Lifesciences. Dr Bortnick is site PI for CSL-Behring; is the recipient of an unrestricted educational grant to the institution from Zoll, Inc; and receives honoraria from ClearView Healthcare, LLC. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

**Central Illustration**
**Definitions of a Variety of Geriatric Syndromes Likely Influencing the Individual Risk of Older AdultsUndergoing Percutaneous Coronary Intervention**

See this image and copyright information in PMC

References

1. Park D.Y., Hanna J.M., Kadian S., et al. In-hospital outcomes and readmission in older adults treated with percutaneous coronary intervention for stable ischemic heart disease. J Geriatr Cardiol. 2022;19:631–642. - PMC - PubMed
1. Buccheri S., D'Arrigo P., Franchina G., Capodanno D. Risk stratification in patients with coronary artery disease: a practical walkthrough in the landscape of prognostic risk models. Interv Cardiol. 2018;13:112–120. - PMC - PubMed
1. Lawton J.S., Tamis-Holland J.E., Bangalore S., et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. J Am Coll Cardiol. 2022;79:e21–e129. - PubMed
1. Gulati M., Levy P.D., Mukherjee D., et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of chest pain. J Am Coll Cardiol. 2021;78:e187–e285. - PubMed
1. Lee C.H., Tan M., Yan A.T., et al. Use of cardiac catheterization for non-ST-segment elevation acute coronary syndromes according to initial risk: reasons why physicians choose not to refer their patients. Arch Intern Med. 2008;168:291–296. - PubMed

Grants and funding

LinkOut - more resources

Full Text Sources
Research Materials
- NCI CPTC Antibody Characterization Program
Miscellaneous
- NCI CPTAC Assay Portal

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Assessment and Management of Older Adults Undergoing PCI, Part 1: A JACC: Advances Expert Panel

Affiliations

Assessment and Management of Older Adults Undergoing PCI, Part 1: A JACC: Advances Expert Panel

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials

Miscellaneous