Aggressive coronary arterty disease treatment appropriate for those over 65

The question: Older people with coronary artery disease generally receive more conservative treatment than younger people. However, more aggressive or invasive treatment is considered life-saving for those who receive it. Might these techniques benefit older people as well?

This study analyzed the results of 2,220 adults randomly assigned to either conservative or aggressive care after they were admitted to a hospital with symptoms of acute coronary artery disease. People treated conservatively were admitted for observation and given a stress test before discharge; aggressive care included angiograms to check for blockages and, if warranted, angioplasty, stenting or surgery. Those aged 65 to 75 who received aggressive treatment had a 39 percent lower risk of heart attack or death within six months than did those of similar age who received conservative care. For people younger than 65, the risk reduction was 22 percent, and it was 56 percent for those older than 75. The oldest group, however, had more problems with major bleeding when treated aggressively.

Who may be affected by these findings? Older people with coronary artery disease.

Caveats: People with additional diseases were excluded from the study, so whether the results would apply to less healthy people is unclear. Merck & Co., which partially funded the study, also employed three of the authors.

Bottom line: Older people with coronary artery disease may want to talk with their doctor about aggressive care.

Find this study in the Aug. 3 issue of the Annals of Internal Medicine; abstract available online at www.annals.org.

Learn more about coronary artery disease at www.nhlbi.nih.gov and www.clevelandclinic.org.