Elderly people with coronary artery disease could have a better prognosis and quality of life if they are given invasive rather than medical treatment, conclude authors of a fast-track study in this week’s issue of THE LANCET.
Coronary artery disease (CAD) is the most common cause of illness and death among people aged 75 years or older. Although the size of this age-group is increasing, death rates remain high, and previous research has generally focused on younger populations. Matthias Pfisterer and colleagues from University Hospital, Basel, Switzerland, did a prospective randomised trial to compare the effects of invasive and medical approaches on the outcome and quality of life of elderly patients with CAD.
305 patients aged 75 years or older who had chronic angina (despite having been given standard medication) were studied. They were randomly assigned either coronary angiography and revascularisation (restoration of coronary blood flow using balloon angioplasty and stenting or coronary artery bypass-graft-surgery) or optimised medical therapy. The primary endpoint was quality of life after 6 months (assessed by questionnaire), and the presence of major adverse cardiac events (death, non-fatal heart attack, or hospital admission for acute coronary syndrome).
After 6 months, angina severity decreased and measures of quality of life increased in both treatment groups; however, these improvements were substantially greater in patients who underwent revascularisation. Major adverse cardiac events occurred in 72 (49%) of patients in the medical group and 29 (19%) in the invasive group.
Matthias Pfisterer comments: “Patients aged 75 years or older with angina despite standard drug therapy benefit more from vascularisation than from optimised medical therapy in terms of symptom relief and quality of life. Therefore, these patients should be offered invasive assessment despite their high risk-profile followed by revascularisation if feasible.”
In an accompanying Commentary (p 945), Wilbert Aronow from Westchester Medical Center and New York Medical College, USA, observes that only 6.7% of 720 000 patients involved in 593 published trials of patients with acute coronary syndromes have been 75 years or older. He confirms Pfisterer and colleagues’ conclusion that elderly patients should be offered invasive evaluation and coronary revascularisation procedures (as clinically indicated), despite their high-risk profile.
Contact: Professor Matthias E Pfisterer, Division of Cardiology, Department of Internal Medicine, University Hospital, CH-4031 Basel, Switzerland; T) 41-61-265-5214; F) 41-61-265-4598; E) pfisterer@email.ch
Dr Wilbert S Aronow, Department of Medicine, Divisions of Cardiology and Geriatrics, Westchester Medical Center and New York Medical College, Valhalla, NY 10595, USA; E) WSAronow@aol.com
Journal
The Lancet