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Why complex and high risk percutaneous coronary interventions should be offered to selected octogenarians/nonagenarians

In this issue of the Journal, Shamkhani et al. analyzed the impact of age on the types, trends, and outcomes of complex high‐risk percutaneous coronary interventions (CHiP) performed for chronic coronary syndromes in the British Cardiovascular Intervention Society (BCIS) registry. The characteristics and outcomes were analyzed in different age groups (G1 < 65 years; G2 65–79 years; and G3 ≥ 80 years). Of 424,290 elective percutaneous coronary interventions (PCI) performed from 2006 to 2017, 138,831 (33.0%) were CHiP and 23.4% of those procedures were performed in ≥80‐year‐old patients. Prior coronary artery bypass graft surgery (CABG) and the presence of chronic total occlusions (CTOs) were the two most high‐risk/complex features in the population and were present in 31.7% and 31.6% of the patient population, respectively. The rates of in‐hospital death in G1, G2, and G3 were 0.2%, 0.3%, and 0.5%, respectively (p < 0.001). The major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding complications were higher with increasing age with the highest rates in ≥80‐year‐old patients. The authors should be congratulated for improving our understanding on the outcomes of CHiP in this understudied patient population.