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Intervention Suggested for Elderly Patients with Chronic Angina: Presented at ESC

By Ed Susman
Special to DG News

BERLIN, GERMANY -- September 3, 2002 -- Researchers said one-year results of a study comparing interventional and medical approaches to treating elderly chronic angina patients suggests that angiography and then, if indicated, angioplasty or bypass surgery is a better route to follow.

"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, in 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 here September 2^nd at the 24^th annual congress of the European Society of Cardiology (ESC), Dr. Pfisterer noted that earlier reports had 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 of life 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 revascularisation 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 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 revascularisation just as younger ones [are]," Dr. Pfisterer said at a press briefing. "By 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 indicate that there is no reason for us to treat elderly chronic angina patients any differently than our other patients," said Lukas Kappenberger, MD, professor of cardiology at Lausanne University, Switzerland.

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