Percutaneous Coronary Intervention for Chronic Total Occlusion in Patients aged < 75 years versus >75 years: A Systematic Review

Background
In younger patients, advancements in percutaneous coronary intervention (PCI) has significantly improved survival in chronic total occlusion (CTO) of coronary arteries but its significance in elderly (>75 years) is not well established.

Methods
PubMed, Ovid Embase and Web of science databases were searched up to August, 2018. Only original studies reporting the comparative use of PCI in CTO for younger and elderly patients were included.

Results
Seven studies including 7717 patients with an overall follow up period of 1.5 to 5 years were included in our review. The baseline characteristics were not significantly different between the two groups in majority of studies, except for BMI, history of stroke and coronary artery bypass graft (CABG) surgery which were reported higher in elderly patients. The angiographic characteristics showed a higher percentage of LAD disease (27.6% vs. 43.4%) in older patients as compared to LCX disease (30% vs. 27.8%) and RCA disease (44.8% vs. 42.8%). CTO PCI was similarly successful in younger and older patients (82%, n=4744 vs. 86.5%, n=1039). The short term all-cause mortality was not significantly different between the two cohorts, however, long-term mortality, cardiac mortality and long term major adverse cardiovascular events (MACE) were lower in younger age group

Conclusions
CTO-PCI can be a good alternative to CABG in select elderly CAD patients owing to its good efficacy and a procedural success equivalent to younger populations. Further studies are required to delineate any potential survival benefit associated with the procedure in elderly population.