Clinical and Angiographic Characteristics of Elderly and Very Elderly Patients With Coronary Artery Disease

Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide, with an increasing burden among older adults. Very elderly patients (≥80 years) often present with atypical symptoms and more extensive coronary involvement yet remain underrepresented in clinical studies. The aim of this prospective observational study was to compare the demographic, clinical, echocardiographic, and coronary angiographic characteristics of elderly (60-79 years) and very elderly (≥80 years) patients with CAD, with the objective of describing age-related clinical profiles that may assist in the evaluation of this increasingly important patient population. Methods: This prospective, observational, single-center study enrolled consecutive patients aged ≥60 years presenting with CAD, including unstable angina, non-ST-elevation myocardial infarction (NSTEMI), ST-elevation myocardial infarction (STEMI), and chronic stable angina. Clinical characteristics, cardiovascular risk factors, echocardiographic findings, and coronary angiographic data were recorded and compared between elderly (60-79 years) and very elderly (≥80 years) groups. CAD was classified as obstructive (≥50% stenosis) or non-obstructive (<50% stenosis). Results: A total of 57 patients were included, comprising 30 patients aged 60-79 years and 27 patients aged ≥80 years. Hypertension (43, 75.4%), diabetes mellitus (26, 45.6%), and dyslipidemia (25, 44.0%) were the most prevalent cardiovascular risk factors. Dyspnea (36, 63.2%) and angina (29, 50.9%) were the most common presenting symptoms. Echocardiographic findings and left ventricular ejection fraction were comparable between groups. Coronary angiography demonstrated single-vessel disease predominantly in patients aged 60-79 years (19, 63.3%), whereas double-vessel disease was more common among very elderly patients (11, 40.7%). The left anterior descending artery was the most frequently involved vessel in both groups. Percutaneous coronary intervention was the predominant management strategy in both elderly (24, 80.0%) and very elderly patients (19, 70.4%). Conclusion: Our study demonstrates that very elderly CAD patients exhibit more extensive coronary involvement, particularly double-vessel disease, despite similar left ventricular function.