Top Things to Know: Coronary Artery Revascularization in the Older Adult Population
Published: November 18, 2025
Prepared by Damluji AA
- The United States (U.S.) population is undergoing a “demographic shift”. According to the U.S. Census Bureau, the number of Americans aged 65 and older is projected to double by 2060, which is over 23% of the total population.
- Each year, over 720,000 Americans suffer from myocardial infarctions or coronary artery disease-related deaths, with older adults disproportionately affected.
- Individuals aged 75 and older account for 30-40% of all acute coronary syndrome hospitalizations, often presenting with complex coronary disease and associated geriatric syndromes like frailty, cognitive impairment, and multimorbidity, complicating revascularization strategies.
- This statement discusses the chronological and biological aging implications related to revascularization in older adults.
- This statement explores “geriatric concepts” to provide a foundation for cardiovascular decision-making for this population.
- The four pillars of risk assessment and evaluation in older adults are examined in this statement and include clinical risk assessment, hemodynamic risk, anatomic and technical risk and geriatric risk.
- Revascularization in older adults in this statement includes several areas of revascularization including STEMI reperfusion strategies, reperfusion vs. medical therapy, PCI vs. CABG in older adults, when surgery is preferable, and complete vs. culprit only revascularization.
- Aortic stenosis is a common disease in the aging population along with coronary artery disease. TAVR in this population is beneficial in those who might be considered inoperative for surgical aortic valve replacement.
- Pharmacotherapy in patients undergoing coronary artery revascularization is addressed in this statement.
- With the aging of the world population and the growing burden of cardiovascular disease presents unique challenges that demand specialized care for older adults undergoing revascularization. With age-related physiological changes, complex coronary anatomy, and prevalent geriatric syndromes, these patients require a nuanced and individualized approach to management.
Citation
Damluji AA, Nanna MG, Mason P, Lowenstern A, Orkaby AR, Washam JB, Kolkailah AA, Beckie TM, Dangas G, Lawton JS; on behalf of the American Heart Association Interventional Cardiovascular Care Committee of the Council on Clinical Cardiology; Council on Arteriosclerosis, Thrombosis and Vascular Biol¬ogy; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; and Council on Quality of Care and Outcomes Research. Coronary Artery Revascularization in the Older Adult Population: A Scientific Statement From the American Heart Association. Circulation. Published online November 18, 2025. doi: 10.1161/CIR.0000000000001387