Still puzzling: Best care for the frail and elderly with coronary artery disease

DURHAM, N.C. – A new study from Duke University Medical Center finds that patients treated solely with medications after suffering from chest pain, heart attack or coronary artery disease are more likely to die during the first year following their initial hospitalization.

"Patients managed medically without stenting or bypass surgery tend to be elderly and frail, and in some sense we feel they have been overlooked," says Matthew Roe, a cardiologist at Duke and the senior author of the study appearing in the August issue of the Journal of the American College of Cardiology: Cardiovascular Intervention. "We wanted to find out what clinical factors were funneling them into a medicine-only group and what happened to them, when compared to patients who received stents and bypass procedures."

Roe led a team of researchers in examining a subset of 8,225 patients from a previous study (the SYNERGY trial) which compared the effects of two different anti-clotting drugs in heart patients. For the current study, researchers included only patients who had undergone cardiac catheterization and who had been found to have at least one significant blockage in a coronary artery. A majority of these patients (52 percent) underwent coronary stent implantation to open their arteries, while 32 percent were medically managed, and 16 percent underwent coronary bypass surgery.

Investigators discovered that patients in the medical management group were more likely to be elderly women with low body weight, and more likely to have had peripheral artery disease, high blood pressure, diabetes or a history of stroke or a previous bypass surgery.