Drugs, Surgery Equally Good for Elderly Chest Pain
People aged 75 and older can withstand the rigors of surgery to treat chest pain, and feel better sooner than if they are treated with gentler drug regimens, Swiss researchers reported on Monday.
And those getting bypass surgery or angioplasty to clear clogged arteries are less likely to have a heart attack or other serious “event,” the researchers found. “People older than 75 years represent the fastest-growing population segment in the western world, and heart and blood vessel disease is the most prominent cause of death and disability in this age group,” said Dr. Matthias Pfisterer, of University Hospital in Basel, Switzerland, who led the study. “Our results show that long-term mortality is similar in invasively treated patients and those treated with optimal drug therapy.” Doctors are often reluctant to operate on elderly people, fearing they may have more side effects. But Pfisterer and colleagues said their study shows surgery may be a better choice than giving drugs alone. “Chest pain relief and improved quality of life are also similar, but invasively managed patients reach this benefit earlier,” Pfisterer said. The Swiss team studied 301 patients with an average age of 80 who had clogged arteries restricting blood flow to the heart. Half got the appropriate surgery, either bypasses or angioplasty, and half got medication including aspirin, statins to lower cholesterol and angiotensin-converting enzyme or ACE inhibitors to improve blood pressure. Reporting in the journal Circulation, published by the American Heart Association, Pfisterer and colleagues said they found that 91.5 percent of patients who got heart bypass surgery or angioplasty were alive six months later, as were 95.9 percent of those on drugs alone. Five years later the numbers were still similar — 70 percent of patients who got operations and 73 percent of those who got drugs alone were alive. They found that 39 percent of the patients who got bypasses or angioplasty had no heart attack for five years and had no need for further surgery or angioplasty, compared with 20 percent of those given drugs alone. And those who got drugs alone were more likely to be hospitalized for chest pain.(Source: Circulation: Reuters Health news: September 2004.)