What is the efficacy of medical therapy versus medical therapy plus PCI for relieving angina in elderly patients?
Findings from the COURAGE trial indicated that initial medical therapy was not significantly less effective than medical therapy plus PCI in relieving angina (73% in the GDMT group at 60 months, versus 80% in the medical therapy plus PCI group). Furthermore, although the mortality rate was 50% higher among patients 65 years of age than among younger patients, there were no significant differences between the two treatment groups in either patients younger or older than 65 years. In the TIME (Trial of Invasive versus Medical Therapy in the Elderly) trial, patients who were assigned to the early revascularization group experienced greater improvement in symptoms at 6 months. This difference disappeared by 12 months, at which time both groups had shown a 2-class improvement in their CCS scores and similar results on other quality-of-life measures.