When 76-year-old Maria Garcia of New Haven walks to her neighborhood grocery store each week, she feels grateful. Five years ago, doctors placed a tiny mesh tube called a stent inside one of her heart arteries to help blood flow more freely. At the time, she wondered whether her age might make the procedure too risky. A major new study suggests her doctors made the right call.
Researchers at Yale University studied more than 176,000 adults who underwent this common heart procedure, called PCI or percutaneous coronary intervention, between 2016 and 2022. Nearly 30 percent of the patients were 75 or older. The study, published in the Journal of the American Geriatrics Society, found something that might surprise many people: when older adults and younger patients had similar overall health, their outcomes were remarkably similar.
"Most of the existing evidence about PCI outcomes comes either from trials that excluded older adults or from registries focused on acute coronary syndromes rather than chronic disease," said Dr. Zafer Akman, a resident physician at Yale who led the study.
At first glance, older patients seemed to have more complications. But they also tended to have more health problems going into the procedure. Once researchers compared patients with similar health backgrounds, the numbers evened out. Older adults actually had a slightly lower risk of major heart-related problems like heart attacks. They faced similar risks of death and serious bleeding compared to younger patients. One difference: adults 75 and older had a 40 percent higher chance of returning to the hospital for heart-related reasons within one year.
Dr. Michael Nanna, a Yale cardiologist who helped lead the study, said the findings challenge assumptions about age and heart treatment. "One of the more interesting findings was that adults aged 75 and older had a somewhat lower adjusted risk of major adverse cardiac events than younger patients," he said. "At first glance, that seems counterintuitive."
The researchers say the explanation is straightforward: doctors are careful about which older patients they recommend for the procedure. The patients who undergo PCI tend to be healthier and more likely to benefit than the general population of older adults with heart disease.
The study couldn't measure everything that matters to patients, including memory, physical strength, family support, and overall quality of life. But the researchers hope their work helps doctors and patients have better conversations about treatment options.
"An 80-year-old who is functionally independent and symptomatic despite medical therapy may be an excellent PCI candidate," Akman said. "A 72-year-old who is frail with multiple comorbidities may not be."
For many older adults, success is not simply living longer, Nanna added. "It is remaining independent, maintaining function and continuing to do the things that matter most to them."