The influence of age on the results of percutaneous coronary interventions in patients with acute coronary syndromes

Acute coronary syndrome (ACS) is one of the most dangerous complications of ischaemic heart disease, occupying a leading place in the structure of global morbidity and mortali­ty. The patient’s age is a critical determinant of an unfavourable clinical prognosis. The problem is particularly acute against the backdrop of the global trend towards an ageing population and frequent atypical clinical manifestations of ischaemia in older age groups. Despite the proven effectiveness of percutaneous coronary interventions (PCI), in real clinical practice, elderly patients often receive incomplete revascularisation due to the technical complexity of the interventions and high expected mortality. Objective: to assess the impact of age on the morphological and functional state of the coronary bed, technical features of percutaneous coronary interventions, and immediate clinical outcomes in patients with acute coronary syndrome. Materials and methods. As part of a retrospective observational single-centre study, the hospital records of 672 patients with ACS for the period 2022–2025 were analysed. For comparative analysis, two groups of patients who underwent PCI during hospitalisation were formed: group 1 (<65 years, n=100) and group 2 (≥65 years, n=100). A comprehensive analysis of clinical and demographic indicators, angiographic picture of coronary artery lesions, surgical parameters, and clinical outcomes at discharge was performed. Results. Angiographic analysis revealed that complex coronary artery lesions were significantly more common in older patients. Diffuse arterial lesions were observed in 47% of patients in group 2 compared with 7% in group 1 (p<0.001). Calcification was recorded in 36% of individuals ≥65 years of age, compared with 9% in the younger group (p<0.001). Bifurcation lesions were found in 59% of the older group, compared with 30% in group 1 (p<0.001). The SYNTAX score was significantly higher in patients ≥65 years of age (median 22.5 vs 11.75; p<0.001). The frequency of achieving complete revascularisation in the older group was significantly lower (32% vs 59%; p<0.001). However, the frequency of TIMI 3 blood flow restoration remained high in both cohorts (93% in group 1 and 89% in group 2; p=0.32). The hospital mortality rate in patients aged ≥65 years was 14%, which was significantly higher than the 3% in the <65 years group (p=0.007). Conclusions. The clinical profile and angiographic picture in patients aged ≥65 years with ACS are more complex, due to the prevalence of diffuse coronary artery disease, severe calcification, and higher SYNTAX scores. This results in high technical complexity of endovascular revascularisation and a lower frequency of achieving complete restoration of myocardial blood supply in this category of patients. Despite technically successful restoration of epicardial blood flow in most cases, the prognosis for older patients remains less favourable, accompanied by a lower left ventricular ejection fraction and increased in-hospital mortality.