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ECS: Intervention Suggested For Elderly Chronic Angina Patients

By Ed Susman

Special to DG News


BERLIN, GERMANY -- September 2, 2002 -- Angiography, followed by angioplasty or bypass surgery if indicated, is effective treatment for elderly chronic angina patients, suggest the results of a one-year study comparing interventional and medical approaches in this group of patients.

"Our study shows that the early risk of mortality in the intervention group is worth it," said Dr. Matthias Pfisterer, professor of cardiology at University Hospital Basel, Switzerland. "We don't think the risk is that big. We believe that for this population of patients over age 75 we should employ interventional procedures that improve symptoms and quality of life as quickly as possible."

In the 12-month data discussed at the 24^th annual congress of the European Society of Cardiology, Dr. Pfisterer noted that earlier reports had suggested that quality of life factors were considerably better for patients receiving the invasive treatment. But that difference disappeared after 12 months -- mainly because 46 percent of the patients in the medical group had continued angina and underwent invasive procedures, too.

Dr. Pfisterer said the study shows that for an older population that has limited years left withholding treatment that can provide long-term pain relief would be a disservice to the patients.

"The remaining medical patients being controlled by drug therapy alone without revascularization reported persistently more angina and lower quality of life scores after one year than patients of the invasive group." he said.

The earlier results of the study conducted among 301 patients over with an average age of 80 years showed a non-significant increase in mortality during the first six months among the patients who received invasive therapy. However, during the second six-month period the mortality reached 2.9 percent among the patients who received invasive treatment and 4.2 percent in the medically-treated population narrowing the gap between the two modalities.

"Our findings suggest that elderly patients with chronic angina should be offered an invasive evaluation and revascularization just as younger ones," Dr. Pfisterer said at a press briefing. "But such a strategy they will benefit significantly more than from optimal medical therapy alone. These benefits clearly outweigh the small early intervention
hazard."

"The results of the study," said Lukas Kappenberger, MD, professor of cardiology at Lausanne University, Switzerland, "indicate that there is no reason for us to treat elderly chronic angina patients any differently that our other patients."

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