Surgery Not Risky for Older Heart Patients

Study finds similar survival rates for medication, surgery in those over 75

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By
HealthDay Reporter

MONDAY, Aug. 30, 2004 (HealthDayNews) -- For years, doctors have thought that patients over the age of 75 with chest pain should be treated gingerly, and given medication rather than surgery.

Now, a new Swiss study in the Aug. 31 online issue of Circulation suggests that may not be the best approach.

Elderly patients who had surgery or angioplasty for their chest pain fared just as well over the long haul as those treated with medication, the authors report. And those who had surgery had better quality of life.

Angina or chest pain occurs when fatty deposits or plaque in the coronary arteries restrict blood flow to the heart. Patients then have chest pain, particularly when they climb stairs, walk or otherwise exert themselves.

In the study, Dr. Matthias Pfisterer, a professor and head of cardiology at University Hospital in Basel, and his team assigned 153 patients to have bypass surgery or angioplasty, in which a "balloon" opens vessel blockages. Another 148 patients were treated with medications such as aspirin or statins. All were 75 or older.

Then the researchers tracked the patients for five years, and found both groups showed similar results. At six months, 91.5 percent treated surgically and 95.9 percent of those on medical therapy were still alive. Survival was similar after 5.1 years, with 70.6 percent of those treated surgically and 73 percent of those treated with medication still alive.

"The traditional thinking was, and is, that interventions carry an increased risk in elderly patients and therefore should be used with great caution," Pfisterer said. While the 30-day death rate is higher in older patients than in younger ones regardless of the type of treatment, he found elderly patients treated with surgery "have quicker relief of symptoms and a better quality of life with fewer drugs."

Quality of life, defined for the study as freedom from heart attacks, cardiac hospitalization or the need for a repeat surgery, was better in the surgery group. While 39 percent of the surgery patients remained free from those major events, just 20 percent of those treated with medications did.

Pfisterer said "patients should be offered invasive evaluation followed by revascularization [repeat procedures if necessary] if ever possible."

Another expert said the study confirms what has already been found in previous studies. "I think it's useful information, but nothing really different from what we have learned from other studies in the past," said Dr. Zi-Jian Xu, a cardiologist at Santa Monica-UCLA Medical Center in Los Angeles. "It's more confirmatory and reassures me that the previous studies hold true."

But the study findings shouldn't overshadow the need for customized therapy, he added.

"The bottom line is we have to individualize every patient based on the patient's individual situation and wishes and preferences," he said, although "early intervention [surgery] tends to reduce the need for future procedures."

But only a patient and his or her doctor can decide which approach is best, he stressed.

More information

To learn more about warning signs of heart disease, visit the American Heart Association.

SOURCES: Matthias Pfisterer, M.D., professor and head, department of cardiology, University Hospital, Basel, Switzerland; Zi-Jian Xu, cardiologist, Santa Monica-UCLA Medical Center, Los Angeles, and assistant clinical professor, medicine, David Geffen School of Medicine, UCLA, Los Angeles; Aug. 31, 2004, Circulation online

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