Treating Chest Pain Study

Posted: Feb. 1, 2005

Elderly people who undergo surgery or angioplasty to treat chest pain fare just as well long-term as those treated with medication, researchers reported in August 2004 in Circulation: Journal of the American Heart Association.

This is the first long-term, randomized, prospective study of chronic angina (chest pain) treatment outcomes among people age 75 and older, researchers said.

“Our results show that long-term mortality is similar in invasively treated patients and those treated with optimal drug therapy. Chest pain relief and improved quality of life are also similar, but invasively managed patients reach this benefit earlier,” said Matthias Pfisterer, M.D., professor and head of the department of cardiology, University Hospital, Basel, Switzerland.

Dr. Pfisterer is the lead investigator of this Trial of Invasive versus Medical Therapy in Elderly Patients (TIME).

Many studies have shown that coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI) – also called angioplasty – provide good symptom relief and outcomes in younger patients. However, physicians often choose the more conservative medication therapy approach for older patients due to concerns that the risks of invasive procedures might outweigh their benefits, he explained.

Study specifics
In the study, 91.5 percent of patients treated invasively and 95.9 percent of those on medical therapy were alive at six months. Survival was still similar after 5.1 years: 70.6 percent for patients treated with the invasive approach and 73 percent for those treated with medication.

The 301 patients (average age 80) studied suffered from angina, which is caused when fatty deposits in the coronary arteries restrict blood flow to the heart.

Patients were assigned randomly to one of two groups: 1) treatment with CABG or PCI and 2) treatment with medication alone. One hundred fifty-three patients were assigned to CABG or PCI; 148 received optimal medication. Optimal medication included aspirin, statins and angiotensin-converting enzyme (ACE) inhibitors.

Quality of life – defined in this study as freedom from heart attacks, cardiac hospitalization or revascularization by CABG or PCI – was 39 percent for the invasively treated patients compared to 20 percent for the medication therapy group. In addition, the medically treated patients required more anti-anginal drugs throughout the study.

Medically treated patients also experienced more non-fatal events – mostly re-hospitalizations for chronic angina that failed to respond to medication. In fact, 43 percent of all medically treated patients continued to experience chronic chest pain and had one of the invasive procedures, usually within the first six months of the study.

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