Risks and benefits of optimised medical and revascularisation therapy in elderly patients with angina -: on-treatment analysis of the TIME trial

Aim To assess treatment effects of optimised medical therapy and PCI or CABG surgery on one-year outcome in patients greater than or equal to75 years old with chronic angina. Methods and Results On-treatment analysis of the TIME data: all re-vascularised patients (REVASC n = 174: 112 randomised to re-vascularisation and 62 to drugs with late re-vascularisation) were compared to all patients on continued drug therapy (MED n = 127: 86 randomised to drugs and 41 to re-vascularisation only). Baseline characteristics of both groups were similar (age 80 4 years). Risk of death at one year (adjusted hazard ratio (HR) = 1.31; 95%-CI: 0.58-2.99; P = 0.52) and of death/ infarction (adjusted hazard ratio = 1.77; 95%-CI 0.91-3.41; P = 0.09) were comparable between REVASC and MED patients. Furthermore, the risk of death within 30 days was even slightly lower among REVASC patients (unadjusted hazard ratio = 0.73; 95%-CI: 0.21-2.53; P = 0.98). Overall, REVASC patients had greater improvements in symptoms and well-being than MED patients (P < 0.01). Surgical patients had similar mortality rates as angioplasty patients, but they also had greater symptomatic improvements (P < 0.01). Conclusion Treated medically, elderly patients with chronic angina have a similarly high 30-day and one-year mortality as patients of the same age being re-vascularised; however, they can expect lower improvements in symptoms and well being. (C) 2004 The European Society of Cardiology. Published by Elsevier Ltd. All rights reserved.