Impact of Age and Comorbidities on Outcomes Following PCI for Chronic Coronary Disease

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Summary of  Journal of the American Geriatrics Society https://doi.org/10.1111/jgs.70457 
Dr. Zafer Akman  et al.

Points

Yale researchers evaluated clinical outcomes from more than 176,000 adults who underwent percutaneous coronary intervention for chronic coronary disease between 2016 and 2022.
Patients aged 75 and older represented nearly 30 percent of the study cohort and exhibited a higher prevalence of baseline comorbidities prior to intervention.
Multivariable adjustment revealed that older adults achieved comparable overall mortality and major bleeding rates to younger patient populations following stent placement.
Older patients demonstrated a 40 percent higher risk of one-year cardiovascular-related rehospitalization despite exhibiting a lower adjusted risk of major adverse cardiovascular events.
Clinical decision-making for elective revascularization should prioritize physiological reserve, functional independence, and patient-centered goals over chronological age alone.

Summary

Percutaneous coronary intervention (PCI) for chronic coronary disease (CCD) in older adults compared to younger cohorts. Older individuals frequently present with significant CAD burden but remain systematically underrepresented in randomized revascularization trials. Led by Zafer Akman and Michael Nanna at the Yale School of Medicine, the investigation analyzed real-world observational data to establish whether biological age independently predicts adverse post-procedural events or if clinical outcomes are primarily governed by baseline comorbidity burden and functional status.

The study evaluated a registry cohort of more than 176,000 adults who underwent elective PCI for CCD between January 2016 and June 2022. Patients aged 75 and older comprised nearly 30% of the study population. Initial unadjusted analysis indicated higher raw complication rates among older adults; however, this subgroup exhibited significantly greater baseline multimorbidity. After adjusting for baseline clinical differences, health background, and procedural risk factors, older patients demonstrated overall mortality and major bleeding risks that were comparable to those of younger cohorts.

Intriguingly, adjusted models revealed that patients aged 75 and older had a slightly lower risk of major adverse cardiovascular events (MACE) relative to younger controls, a finding attributed to highly selective patient screening by clinicians. Conversely, older adults experienced a 40% higher risk of 1-year cardiovascular rehospitalization post-PCI. The authors conclude that overall physiological health, functional independence, and comorbidity burden should guide PCI selection in CCD rather than chronological age alone.

Link to the article: https://agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.70457

References

Akman, Z., Park, D. Y., Sohal, S., Li, D. K., Hu, J., Romero, L., Rossi, R., Nouri, A., Nezhad, S. A., Al Mouslmani, M., Campbell, G., Kochar, A., Frampton, J., Damluji, A. A., & Nanna, M. G. (2026). Outcomes after percutaneous coronary intervention for chronic coronary disease in adults ≥ 75 versus < 75 years. Journal of the American Geriatrics Society, 74(7), 1910–1918. https://doi.org/10.1111/jgs.70457