Revascularization Aids Elderly Diabetic Angina Patients

Elderly diabetic patients with chronic angina pectoris generally have a worse outcome than comparable patients without diabetes. However, both groups gain similar benefits from revascularization.

Dr. Mathias E. Pfisterer Senior investigator stated that, "elderly patients and their physicians may choose either an invasive strategy with early symptom relief and improvement in well-being at the ‘cost’ of an early investigation and revascularization, or a medical strategy with a similar long-term outcome, but more drugs and a greater than 50% chance of the need for late revascularization for refractory symptoms."

Dr. Pfisterer of University Hospital Basel and colleagues evaluated 301 patients 75 years of age or older with symptomatic coronary artery disease. Sixty-nine subjects also had diabetes mellitus.

The team examined the difference in outcome between the diabetic and nondiabetic patients over a median of 4.1 years of follow-up. The findings are published in the July issue of the American Journal of Cardiology.

Compared with nondiabetics, patients with diabetes had a greater incidence of hypertension, risk factors, previous heart failure and myocardial infarction. Their mortality (41%) was also significantly greater than in those without the disease (25%).
However, in both groups, the overall survival was 61% without revascularization, but rose to 79% with revascularization.
Event-free survival with revascularization was 41% in diabetics and 53% in nondiabetics. In those who did not undergo the procedure, the corresponding proportions were 11% and 40%.

Dr. Pfisterer also noted that cost-effectiveness analyses "showed that the early increased costs of revascularization are balanced by increased private practitioner’s charges and symptom-driven late revascularizations in medical strategy patients."

"Increased intervention costs should not be an argument to withhold the invasive strategy from elderly patients with symptomatic chronic coronary artery disease," he concluded. These patients "with chronic angina despite standard medical therapy should be offered invasive evaluation and revascularization if feasible."
Am J Cardiol 2005;96:193-198.

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