Yonsei Med J.  2016 Mar;57(2):382-387. 10.3349/ymj.2016.57.2.382.

Percutaneous Coronary Intervention Is More Beneficial Than Optimal Medical Therapy in Elderly Patients with Angina Pectoris

Affiliations
  • 1Cardiovascular and Arrhythmia Center, College of Medicine, Chung-Ang University, Seoul, Korea.
  • 2Department of Medicine, School of Medicine, Kangwon National University, Chuncheon, Korea.
  • 3Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Korea. mkhong61@yuhs.ac
  • 4Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.
  • 5Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 6Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea.

Abstract

PURPOSE
Data comparing the clinical benefits of medical treatment with those of percutaneous coronary intervention (PCI) in an elderly population with angina pectoris are limited. Therefore, we evaluated the efficacy of elective PCI versus optimal medical treatment (OMT) in elderly patients (between 75 and 84 years old) with angina pectoris.
MATERIALS AND METHODS
One hundred seventy-seven patients with significant coronary artery stenosis were randomly assigned to either the PCI group (n=90) or the OMT group (n=87). The primary outcome was a composite of major adverse events in the 1-year follow-up period that included cardiovascular death, non-fatal myocardial infarction, coronary revascularization, and stroke.
RESULTS
Major adverse events occurred in 5 patients (5.6%) of the PCI group and in 17 patents (19.5%) of the OMT group (p=0.015). There were no significant differences between the PCI group and the OMT group in cardiac death [hazard ratio (HR) for the PCI group 0.454; 95% confidence interval (CI) 0.041-5.019, p=0.520], myocardial infarction (HR 0.399; 95% CI 0.039-4.050, p=0.437), or stroke (HR 0.919; 95% CI 0.057-14.709, p=0.952). However, the PCI group showed a significant preventive effect of the composite of major adverse events (HR 0.288; 95% CI 0.106-0.785, p=0.015) and against the need for coronary revascularization (HR 0.157; 95% CI 0.035-0.703, p=0.016).
CONCLUSION
Elective PCI reduced major adverse events and was found to be an effective treatment modality in elderly patients with angina pectoris and significant coronary artery stenosis, compared to OMT.

Keyword

Percutaneous coronary intervention; elderly patient; angina pectoris

MeSH Terms

Aged
Aged, 80 and over
Angina Pectoris/mortality/*therapy
Coronary Stenosis/therapy
Female
Humans
Male
Myocardial Infarction/prevention & control/*therapy
*Percutaneous Coronary Intervention
Proportional Hazards Models
Prospective Studies
Republic of Korea
Stroke/epidemiology
Treatment Outcome

Figure

  • Fig. 1 Rate of composite adverse events for the 1 year follow-up duration. OMT, optimal medical treatment; PCI, percutaneous coronary intervention; CI, confidence interval.


Cited by  1 articles

Comparison of Clinical Outcomes between the Right and Left Radial Artery Approaches from the Korean Transradial Coronary Intervention Registry
Ji Young Park, Seung-Woon Rha, Byong Geol Choi, Dong Ju Oh, Cheol Ung Choi, Young-Jin Youn, Junghan Yoon
Yonsei Med J. 2017;58(3):521-526.    doi: 10.3349/ymj.2017.58.3.521.


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