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

Author:

Cacciatore Stefano1ORCID,Spadafora Luigi2ORCID,Bernardi Marco2ORCID,Galli Mattia3,Betti Matteo45,Perone Francesco6ORCID,Nicolaio Giulia7,Marzetti Emanuele18ORCID,Martone Anna Maria8,Landi Francesco18,Asher Elad9ORCID,Banach Maciej10ORCID,Hanon Olivier11,Biondi-Zoccai Giuseppe1213ORCID,Sabouret Pierre1415ORCID

Affiliation:

1. Department of Geriatrics, Orthopedics and Rheumatology, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168 Rome, Italy

2. Department of Clinical, Internal Medicine, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00186 Rome, Italy

3. Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Italy

4. University of Milan, 20122, Milan, Italy

5. Monzino IRCCS Cardiological Center, 20137 Milan, Italy

6. Cardiac Rehabilitation Unit, Rehabilitation Clinic “Villa delle Magnolie”, 81020 Castel Morrone, Caserta, Italy

7. Department of Experimental and Clinical Medicine and Geriatrics, University of Florence, Azienda Ospedaliero Universitaria Careggi, Largo Giovanni Alessandro Brambilla 3, 50134 Florence, Italy

8. Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy

9. The Jesselson Integrated Heart Center, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University, P.O. Box 12271, Jerusalem 9112102, Israel

10. Department of Preventive Cardiology, Polish Mother’s Memorial Hospital Research Institute (PMMHRI), Medical University of Lodz (MUL), 93-338 Lodz, Poland

11. Assistance Publique Hôpitaux de Paris, Geriatric Department, Broca Hospital, University of Paris Cité, 54–56 Rue Pascal, 75013 Paris, France

12. Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100 Latina, Italy

13. Mediterranea Cardiocentro, Via Orazio 2, 80122 Naples, Italy

14. Heart Institute, Pitié-Salpétrière Hospital, ACTION-Group, Sorbonne University, 47–83 Bd de l’Hôpital, 75013 Paris, France

15. Department of Cardiology, National College of French Cardiologists, 13 Rue Niépce, 75014 Paris, France

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.

Funder

Università Cattolica del Sacro Cuore

Italian Ministry of Health

Centro Studi Achille e Linda Lorenzon

Next Generation EU

Union-NextGenerationEU

European Union-NextGenerationEU

Publisher

MDPI AG

Subject

General Medicine

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