Percutaneous Coronary Intervention Is More Beneficial Than Optimal Medical Therapy in Elderly Patients with Angina Pectoris.
10.3349/ymj.2016.57.2.382
- Author:
Hoyoun WON
1
;
Ae Young HER
;
Byeong Keuk KIM
;
Yong Hoon KIM
;
Dong Ho SHIN
;
Jung Sun KIM
;
Young Guk KO
;
Donghoon CHOI
;
Hyuck Moon KWON
;
Yangsoo JANG
;
Myeong Ki HONG
Author Information
1. Cardiovascular and Arrhythmia Center, College of Medicine, Chung-Ang University, Seoul, Korea.
- Publication Type:Multicenter Study ; Original Article ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
- Keywords:
Percutaneous coronary intervention;
elderly patient;
angina pectoris
- MeSH:
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
- From:Yonsei Medical Journal
2016;57(2):382-387
- CountryRepublic of Korea
- Language:English
-
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.
