Elderly heart disease patients who undergo coronary revascularisation procedures enjoy better long-term health status and quality of life as compared to those who are treated with drug therapy. The burden of heart disease in the elderly, combined with reports of poor outcomes following bypass surgery or percutaneous coronary intervention (PCI) such as balloon angioplasty, have led to the uncertainty as to whether these procedures should be routinely offered to elderly patients. Researchers from the University of Alberta Hospital, Edmonton, Canada have found, significantly improved outcomes associated with revascularisation procedures in both a small, randomised trial and a large observational study. They examined the heath status at 4 years for a group of elderly patients with cardiac disease registered in the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH) initiative. A total of 21,573 patients in Alberta underwent cardiac catheterisation, an invasive test that looks for coronary blockages, between 1995 and 1998 and most subjects were surveyed 1, 3 and 5 years afterward. Crude and risk-adjusted outcomes were determined and compared for patients treated with angioplasty or bypass surgery versus medical therapy. Scores of patients younger than 70 years and those between 70 and 79 years, on all dimensions of the Seattle Angina Questionnaire were significantly better for patients treated with revascularisation than with medical therapy. Among patients older than 80 years, scores were significantly better for patients treated with bypass surgery. All scores were stable or improved at 3 years, and they continued to favour revascularisation. The findings imply that the benefits of revascularisation procedures performed in appropriately selected elderly patients extend not only to clinical outcomes, but also to long-term enhancement of quality-of-life. Therefore, age should not deter against revascularisation.
European Heart Journal,
August 2006