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Review
. 2023 Aug 11;12(16):5233.
doi: 10.3390/jcm12165233.

Management of Coronary Artery Disease in Older Adults: Recent Advances and Gaps in Evidence

Stefano Cacciatore  1 , Luigi Spadafora  2 , Marco Bernardi  2 , Mattia Galli  3 , Matteo Betti  4   5 , Francesco Perone  6 , Giulia Nicolaio  7 , Emanuele Marzetti  1   8 , Anna Maria Martone  8 , Francesco Landi  1   8 , Elad Asher  9 , Maciej Banach  10 , Olivier Hanon  11 , Giuseppe Biondi-Zoccai  12   13 , Pierre Sabouret  14   15
Affiliations
Review

Management of Coronary Artery Disease in Older Adults: Recent Advances and Gaps in Evidence

Stefano Cacciatore et al. J Clin Med. .

Abstract

Coronary artery disease (CAD) is highly prevalent in older adults, yet its management remains challenging. Treatment choices are made complex by the frailty burden of older patients, a high prevalence of comorbidities and body composition abnormalities (e.g., sarcopenia), the complexity of coronary anatomy, and the frequent presence of multivessel disease, as well as the coexistence of major ischemic and bleeding risk factors. Recent randomized clinical trials and epidemiological studies have provided new data on optimal management of complex patients with CAD. However, frail older adults are still underrepresented in the literature. This narrative review aims to highlight the importance of assessing frailty as an aid to guide therapeutic decision-making and tailor CAD management to the specific needs of older adults, taking into account age-related pharmacokinetic and pharmacodynamic changes, polypharmacy, and potential drug interactions. We also discuss gaps in the evidence and offer perspectives on how best in the future to optimize the global strategy of CAD management in older adults.

Keywords: aged; antithrombotic agents; coronary artery disease; frailty; hemorrhage; ischemia; multimorbidity.

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Conflict of interest statement

Maciej Banach. is part of the speaker’s bureau of Amgen, Daichii Sankyo, Kogen, KRKA, Polpharma, Mylan/Viatris, Novartis, Novo-Nordisk, Sanofi-Aventis, Teva, and Zentiva; has consulted for Amgen, Daichii Sankyo, Esperion, NewAmsterdam, Novartis, Novo-Nordisk, Polfarmex, and Sanofi-Aventis; and has received grants from Amgen, Daichii Sankyo, Mylan/Viatris, and Sanofi. Olivier Hanon has received speaker fees from Novartis, Boehringer-Ingelheim, Bayer, BMS, Pfizer, AstraZeneca, Servier, Vifor, Leo pharma, and Sanofi Aventis. Giuseppe Biondi-Zoccai has consulted for Amarin, Balmed, Cardionovum, Crannmedical, En-docore Lab, Eukon, Guidotti, Innovheart, Meditrial, Microport, Opsens Medical, Terumo, and Translumina, all outside of the present work. Pierre Sabouret has received speaker fees from AstraZeneca, Amgen, Axis TV, BMS, Les laboratoires Servier, Novartis, Novonordisk, Sanofi, and Vifor, outside the present work. Emanuele Marzetti has received speaker fees from Abbot, Difass International, Nestlè, and Nutricia, and consulting fees from Cepton Strategies and Pfizer, all outside of the present work. All other authors report no conflict of interest.

Figures

Figure 1
Figure 1
Domains affected by coronary heart disease in older adults (created with Biorender.com, accessed on 30 June 2023).
Figure 2
Figure 2
Screening for frailty is essential to guide clinical decision-making in older adults with coronary artery disease. Abbreviations: BMI: Body Mass Index; CABG: Coronary Artery Bypass Grafting; CFS: Clinical Frailty Scale; CIRS-G: Cumulative Illness Rating Scale-Geriatric; EFT: Essential Frailty Toolset; GDS: Geriatric Depression Scale; MMSE: Mini Mental State Examination; MNA: Mini Nutritional Assessment; MoCA: Montreal Cognitive Assessment; MRC: Medical Research Council Dyspnoea Scale; NRS: Numerical Rating Scale; NYHA: New York Heart Association; PCI: Percutaneous Coronary Intervention; SPMSQ: Short Portable Mental State Questionnaire; SPPB: Short Physical Performance Battery; TUG: Timed Up and Go Test.
Figure 3
Figure 3
Challenges in therapeutic management of coronary artery disease in older adults (created with Biorender.com, accessed on 30 June 2023).
See this image and copyright information in PMC

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