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

Kaiser, Christoph ; Kuster, Gabriela M. ; Erne, Paul ; Amann, Wolfgang ; Naegeli, Barbara ; Osswald, Stefan ; Buser, Peter ; Schläpfer, Heinz ; Brett, Wolfgang ; Zerkowski, Hans-Reinhard ; Schindler, Christian ; Pfisterer, Matthias

In: European Heart Journal, 2004, vol. 25, no. 12, p. 1036-1042

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    Title
    • Risks and benefits of optimised medical and revascularisation therapy in elderly patients with angina - on-treatment analysis of the TIME trial
    Author
    • Kaiser, Christoph. Department of Cardiology, University Hospitals Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Kuster, Gabriela M.. Department of Cardiology, University Hospitals Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Erne, Paul. Kantonsspital, Lucern, Switzerland
    • Amann, Wolfgang. University Hospital, Zürich, Switzerland
    • Naegeli, Barbara. Triemli Spital, Zürich, Switzerland
    • Osswald, Stefan. Department of Cardiology, University Hospitals Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Buser, Peter. Department of Cardiology, University Hospitals Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Schläpfer, Heinz. Kantonsspital, Biel, Switzerland
    • Brett, Wolfgang. Department of Cardiology, University Hospitals Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Zerkowski, Hans-Reinhard. Department of Cardiology, University Hospitals Basel, Petersgraben 4, 4031 Basel, Switzerland
    • Schindler, Christian. Institute of Social and Preventive Medicine, University of Basel, Switzerland
    • Pfisterer, Matthias. Department of Cardiology, University Hospitals Basel, Petersgraben 4, 4031 Basel, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:295853
    Summary
    Aim To assess treatment effects of optimised medical therapy and PCI or CABG surgery on one-year outcome in patients ⩾75 years old with chronic angina. Methods and Results On-treatment analysis of the TIME data: all re-vascularised patients (REVASC \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(n=174\) \end{document}: 112 randomised to revascularisation and 62 to drugs with late revascularisation) were compared to all patients on continued drug therapy (MED \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(n=127\) \end{document}: 86 randomised to drugs and 41 to revascularisation 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; \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(P=0.52\) \end{document}) and of death/infarction (adjusted hazard ratio=1.77; 95%-CI 0.91-3.41; \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(P=0.09\) \end{document}) 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; \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \(P=0.98)\) \end{document}. Overall, REVASC patients had greater improvements in symptoms and well-being than MED patients \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((P{<}0.01)\) \end{document}. Surgical patients had similar mortality rates as angioplasty patients, but they also had greater symptomatic improvements \batchmode \documentclass[fleqn,10pt,legalpaper]{article} \usepackage{amssymb} \usepackage{amsfonts} \usepackage{amsmath} \pagestyle{empty} \begin{document} \((P{<}0.01)\) \end{document}. 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