Sripal Bangalore

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We know from prior observational research that the risks of pursuing revascularization are much higher in older adults. Older adults have a greater risk of acute kidney injury, of major bleeding, and that risk has to be offset with the health status improvement. I think the importance of this paper is that it shows that older adults actually can get some improvements in their health status, but it might not be as much as we thought and that has to be taken into consideration when we decide to refer older adults to invasive management.

Ramya C. Mosarla

Interventional cardiologist, New York University · New York University

11d

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Although several patient- and procedural risk factors appear to be independently associated with IPCA, few are modifiable. Still, the findings in the present study are valuable in that they may inform case selection for PCI and risk-benefit conversations with patients, particularly among those with elective indications for coronary revascularization focused on improving quality of life.

Sripal Bangalore

Interventional cardiologist, NYU Langone Health

4d

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routine component of state-of-the-art PCI for the treatment of complex coronary artery disease.

Magnus Ohman

Professor of medicine, Duke University · Duke University

5w

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While a lower dose seemed intuitive, it was safe but not more effective. Future dedicated studies need to continue to find the right therapies for the vulnerable elderly patients.

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I wouldn't say the direction of the findings was surprising, but the magnitude certainly was. What stood out most was the size of the treatment gap — over 40% of people who were clearly eligible under the new guideline were not receiving treatment. That really highlights that the issue is not just defining who should be treated, but ensuring those recommendations are implemented in real-world practice.

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Thus, for most patients with moderate or severe ischemia, exclusion of LMD will require anatomical imaging with either CTA or invasive coronary angiography.

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An important thing that we address in this review article is the concept that one size does not fit all with regard to our elderly patients. Obviously, the elderly patients who qualify to be enrolled in clinical trials may not be the same as those that we see in real-world clinical practice. Additionally, when we look at the elderly overall as a cohort, there remain a lot of unanswered questions simply because in the vast majority of trials that we conduct, the elderly only represent a subgroup.