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Treatment of stable angina: medical and invasive therapy--implications for the elderly
1Cardiology Division, New York-Weill Cornell Medical Center, New York, NY 10021, USA. sscheidt@med.cornell.edu
Insights
Current treatments for chronic stable angina, including revascularization like bypass surgery and angioplasty, are reviewed. While age increases risks, revascularization may benefit higher-risk elderly patients with coronary artery disease.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Chronic stable angina management involves reviewing current therapeutic options.
- Revascularization procedures, including coronary artery bypass surgery (CABG) and percutaneous transluminal coronary angioplasty (PTCA), are key interventions.
Observation:
- Advancing age is a significant risk factor for both CABG and PTCA, yet elderly individuals face higher coronary event risks without intervention.
- In-hospital mortality for CABG in patients over 80 is approximately 8%, with similar rates in highly selected patients over 90 undergoing elective procedures.
- Limited randomized trials comparing invasive versus noninvasive therapy for stable coronary artery disease exist, with insufficient patient numbers for definitive conclusions.
Findings:
- Data suggest that higher-risk patients generally experience better outcomes with revascularization therapies.
- Risk stratification methods are crucial for guiding treatment decisions in chronic stable angina.
Implications:
- Revascularization may be a beneficial therapeutic strategy for select high-risk elderly patients with chronic stable angina.
- Further research with larger patient cohorts is needed to definitively establish the superiority of invasive versus noninvasive therapies.
- Emerging therapies like transmyocardial revascularization, external counterpulsation, and gene therapy warrant further investigation for angina treatment.
Abstract:
Currently available therapies for chronic stable angina are reviewed. Revascularization, i.e., coronary artery bypass surgery and percutaneous transluminal coronary angioplasty, is summarized briefly, with short- and long-term results summarized from several large registries and review articles. Advancing age is a risk factor for both coronary artery bypass surgery and percutaneous transluminal coronary angioplasty, but risks of coronary events are also higher without interventions in the elderly. In-hospital mortality for coronary artery bypass surgery is about 8% for patients over age 80 in one large national registry and not much different in elective coronary artery bypass surgery in highly-selected patients over age 90 in one institution. The few randomized trials of invasive vs. noninvasive therapy for stable coronary artery disease are described. Although patient numbers in available studies are too small to be conclusive as to which type of therapy is generally better, data appear to suggest that higher-risk patients have better outcomes with revascularization. Methods of risk stratification are discussed. Finally, unusual therapies for angina are briefly noted, including transmyocardial revascularization, external counterpulsation, and gene therapy.
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