ABC | Volume 112, Nº5, May 2019

Updated Updated Geriatric Cardiology Guidelines of the Brazilian Society of Cardiology – 2019 Arq Bras Cardiol. 2019; 112(5):649-705 Treatment of chronic coronary disease in elderly patients General measures ● Balanced diet ● Weight control ● Regular practice of physical activity ● Vaccination schedule completion ● Tobacco cessation ● Intensive blood pressure control Antiatherosclerotic medications ● Statins ● Antiplatelets ● Renin-angiotensin system inhibitors (ACEI/ARB) Antianginal medications ● Beta-blockers ● Calcium channel blockers ● Nitrates ● Trimetazidine Myocardial revascularization ● Percutaneous coronary intervention ● Myocardial revascularization surgery ACEI: angiotensin converting enzyme inhibitors;ARB: angiotensin receptor blockers. associated comorbidities tend to affect the surgical procedure even more. 151 In conclusion, in addition to the previously mentioned facts, therapeutic recommendations must consider many other relevant factors such as biological aspects of frailty, psychological competence, economic and social support, Diagnostic evaluation of chronic coronary disease in elderly patients Method Positive aspects Possible limitations Grade of recommendation Level of evidence EKG Easily obtained. Detection of inactive zones and conduction disorders Low accuracy I B Ergometric test Availability. Moderate accuracy in detecting ischemia Locomotive difficulties. Resting EKG alterations I B Stress echocardiography (exercise, dobutamine, or dipyridamole) Detection and evaluation of the extent of ischemia. Evaluation of LV function Echocardiography window. Cost I B Scintigraphy Detection and evaluation of the extent of ischemia. Does not depend on preexisting electrocardiographic alterations. Evaluation of LV function Lower availability. Cost I B Coronary computed tomography angiography Detection of obstructions Calcification in the elderly patient decreases diagnostic accuracy IIa B Coronary magnetic resonance angiography Detection of obstructions Lower accuracy. Difficult to obtain IIb C Cardiac magnetic resonance LV function. Areas of fibrosis Difficult to obtain IIb C EKG: electrocardiogram; LV: left ventricle. among others. This makes this choice an optimal example of personalized therapy centered on the elderly individual who is affected by CAD. 2.3. General Recommendations – Chronic Coronary Artery Disease in Elderly Patients Recommendations for general measures and antiatherosclerotic use Procedure/medication Grade of recommendation Level of evidence Balanced diet I A Weight control I B Physical activity I B Vaccination against influenza I B Tobacco cessation I A BP control < 140 mmHg I A BP control < 120 mmHg IIa B Statins I A Antiplatelets I A ACEI/ARB I A ACEI: angiotensin converting enzyme inhibitors;ARB: angiotensin receptor blockers. BP: blood pressure. 668