NEW YORK (Reuters Health) – In older patients with stable coronary disease, adding percutaneous coronary intervention (PCI) to optimal medical therapy neither improves nor worsens their outcomes, new research shows.

“These data support continued adherence to the published American College of Cardiology/American Heart Association treatment guidelines, which endorse optimal medical therapy as the preferred initial management strategy for stable coronary artery disease patients, regardless of age,” Dr. William E. Boden, from Buffalo General Hospital, New York, and co-authors state.

Their conclusions are based on data from individuals with stable coronary disease who were participants in the Clinical Outcomes Utilizing Revascularization and Aggressive druG Evaluation (COURAGE) trial, including 904 patients age 65 or older at baseline and 1381 patients younger than 65.

During a median follow-up period of 4.6 years, no significant differences in clinical outcomes were noted among older patients who received optimal medical therapy with or without PCI, according to the report in the Journal of the American College of Cardiology for September 29.

Neither age nor treatment assignment affected the achievement of treatment targets for blood pressure, low-density lipoprotein cholesterol, adherence to diet and exercise, and angina-free status.

Older patients had a 2- to 3-fold increased mortality rate relative to younger patients, but comparable rates of MI, stroke, and other major cardiac events, the investigators report.

When the investigators analyzed the percentages of patients that were angina-free at 60 months of follow-up, rates were 80% with PCI and 73% without it (p=0.16) in the older group, and 73% with PCI and 72% without it (p=0.83) in the younger group.

“Optimal medical therapy is as effective in stable coronary artery disease patients aged 65 and older as in patients less than 65 years,” the researchers state, “and PCI, when added to optimal medical therapy, does not reduce clinical events or improve angina relief during long-term follow-up.”

“The results of the current COURAGE trial subset analysis provide important, new information on the clinical benefit of optimal medical therapy,” the authors conclude.

“Not only can high rates of effective treatment be achieved in older subjects with the use of aggressive pharmacologic therapy and lifestyle intervention during long-term follow-up,” they add, “but clinical events can be, likewise, favorably impacted.”

Reference:
J Am Coll Cardiol 2009;54:1303–1308.