Most angina patients 75 and older should be offered revascularization


By Gary Faulds, PhD

STOCKHOLM (Reuters Health) – Elderly patients with angina pectoris generally show improvement in symptoms after revascularisation and have increased quality of life compared with those managed only medically. These are the conclusions drawn from the 6-month results of the TIME (Trial of Invasive versus Medical Therapy in the Elderly) study, presented here Monday at the XXIII European Society of Cardiology Congress.

The ongoing TIME study is looking at patients 75 to 90 years of age in 14 centers across Switzerland. The preliminary analysis is based on 301 patients, 43% female, who were classified as very high risk, with more than 50% having a history of acute myocardial infarction.

Patients were randomised such that 148 received optimised medical therapy and 153 underwent left heart catheterisation followed by angioplasty or bypass surgery, if possible. Nearly three-quarters of the patients in the invasive therapy group underwent revascularisation. Nearly one-third of the medical group required revascularisation during the 6 months of the trial, despite receiving an average of 3.3 anti-anginal drugs.

Patients in both groups showed improvement in symptomatic status and self-assessed quality of life after 6 months, but improvement was greater in the revascularised group. Overall, death, MI and hospitalisation for unstable angina or impending infarction occurred 2.5 times more frequently in the patients treated medically (p < 0.0001).

The overall 6-month mortality rate was low (6%), although there was a small and statistically nonsignificant increased mortality risk in the invasive therapy group.

The principal investigator, Professor Matthias Pfisterer from University Hospital Basel, Switzerland, noted that patients should be made aware of the increased risk associated with revascularisation compared with medical therapy, but stressed that this could disappear if the trend seen in cardiovascular events in this short-term analysis translates to mortality in the medium- to long term.

The 6-month data suggest, Prof. Pfisterer said, that "if coronary anatomy is suitable for revascularisation–and three-quarters of the patients were suitable–they should be revascularised to reduce symptoms and to improve quality of life, and with less anti-anginal drugs."

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