A heart patient’s age is easy to measure, but it may be a poor shortcut for deciding who should receive an artery-opening procedure.
A large Yale-led study suggests that older adults selected for the procedure can have results surprisingly similar to younger patients once differences in their health are considered.
The research examined PCI, a procedure used to improve blood flow through narrowed coronary arteries. PCI is commonly performed by guiding a small catheter into an artery and using a balloon and often a stent to open a narrowed area.
Coronary arteries deliver oxygen-rich blood to the heart muscle. Over many years, deposits called plaque can build up inside these vessels and reduce blood flow, a condition known as coronary artery disease.
For people with stable or chronic coronary disease, doctors often begin with medicines and lifestyle changes. PCI may be considered in selected patients, particularly when symptoms continue or when doctors believe opening an artery could provide meaningful benefit.
Decisions become more complicated in older adults. People over 75 are more likely to have coronary disease, but they are also more likely to have other medical conditions that could increase the risks of a procedure.
At the same time, older adults have historically been underrepresented in many clinical trials. This means some treatment decisions have had to rely on evidence that does not fully reflect the population most likely to develop heart disease.
To investigate what happens in real medical practice, researchers analyzed records from more than 176,000 people who received PCI for chronic coronary disease from January 2016 through June 2022. Nearly 30% were at least 75 years old.
The Yale-led research was published in the Journal of the American Geriatrics Society. Dr. Zafer Akman was first author, with cardiovascular specialist Dr. Michael Nanna serving as senior author.
A simple comparison initially made the older group look more vulnerable. Older adults experienced more complications, but they also began with a heavier burden of health problems.
This is an important statistical issue. If a 78-year-old has kidney disease, diabetes and several previous heart problems while a 55-year-old has none of them, comparing the two people only by age can create a misleading picture.
The researchers therefore adjusted their analysis so that older and younger patients with more similar medical backgrounds could be compared. After doing this, age by itself appeared much less important.
Patients aged 75 and older had a similar adjusted risk of death and serious bleeding compared with younger adults. They even had a somewhat lower adjusted risk of major harmful heart events.
At first, that finding might sound as though older patients somehow fare better because they are older. The researchers stressed that this is not what the study shows.
A likely explanation is patient selection. Doctors may be especially cautious about recommending an invasive heart procedure to an older adult, meaning that the older patients who ultimately undergo PCI tend to be healthier or more likely to tolerate it.
This effect is sometimes described as selection bias. The results of people chosen for a treatment do not necessarily tell us what would happen if that treatment were given to everyone of the same age.
The study also identified a less reassuring finding. Adults aged 75 and older had a roughly 40% higher risk of a heart-related hospital admission within one year.
This means age should not simply be ignored. Rather, the research suggests doctors should look beyond age and examine the individual characteristics that determine whether a person is likely to recover well and gain something meaningful from treatment.
One of those characteristics is physical function. An 82-year-old who walks independently, manages daily life without assistance and remains socially active may be biologically very different from a younger patient who is frail and has multiple serious diseases.
Frailty can reduce the body’s ability to cope with illness and recover from medical procedures. Memory problems, mobility limitations, kidney disease, medication burden and the availability of support at home can also influence whether a treatment is a sensible choice.
Patient goals matter just as much. A procedure that reduces symptoms enough to let someone shop independently, garden, travel or spend active time with family may be extremely valuable even if it does not dramatically extend life.
Senior author Michael Nanna noted that success for many older adults is about more than survival. Maintaining independence and continuing activities that give life meaning can be central parts of a treatment decision.
The study could not fully measure several of these outcomes. The available information did not completely capture thinking and memory, physical abilities, social support, symptoms or quality of life.
That is an important limitation because these factors may strongly influence both the decision to undergo PCI and the way a patient judges the result. The research also used existing patient data rather than randomly assigning people to different treatments.
Because of this, the findings should not be interpreted as proof that PCI is safe or beneficial for every person aged 75 or older. They also do not show that older adults should automatically receive the procedure whenever younger patients would.
What the study does provide is strong real-world evidence against using age as the only gatekeeper. The large number of patients strengthens the analysis, while the remaining selection effects and missing information about frailty and quality of life mean individual judgment is still essential.
In the end, the study supports a shift from age-based medicine toward person-based medicine. When doctors and older patients discuss PCI, the most useful conversation may focus on overall health, function, symptoms, risks and what the patient wants their treatment to make possible.
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Source: Yale University.
