Long-term outcome in elderly patients with chronic angina managed invasively versus by optimized medical therapy - Four-year follow-up of the randomized Trial of Invasive versus Medical Therapy in Elderly patients (TIME)

Background-There are no prospective trial data on long-term outcomes in 80-year-old patients with chronic angina with regard to antiischemic therapy. Methods and Results-To assess long-term survival and quality of life (QoL) in patients from the Trial of Invasive versus Medical Therapy in the Elderly (TIME), all 276 1-year survivors (of a total 301 patients) were contacted after a median of 3.1 years (range, 1.1 to 5.9 years). At baseline, patients were 80 +/- 4 years old, 42% were women, and they were designated as being in angina class 3.2 +/- 0.7, despite their taking 2.5 +/- 0.7 antiischemic drugs. Patients were randomized to an invasive (n = 153) or an optimized medical (n = 148) strategy. Survival of invasive-strategy versus medical-strategy patients was 91.5% versus 95.9% after 6 months, 89.5% versus 93.9% after 1 year, and 70.6% versus 73.0% after 4.1 years (P = NS). Mortality was independently increased in patients greater than or equal to80 years of age, with prior heart failure, ejection fraction less than or equal to0.45, and greater than or equal to2 comorbidities, and without revascularization within the first year. Revascularization within the first year improved survival in invasive-strategy (P = 0.07) and medical-strategy (P < 0.001) patients. The early benefit of both treatments in angina relief and QoL was maintained long term, but freedom from major events remained higher in invasive-strategy versus medical-strategy patients (39% versus 20%, P < 0.0001). Conclusions-Long-term survival was similar for patients assigned to invasive and medical treatment. The benefits of both treatments in angina relief and improvement in QoL were maintained, but nonfatal events occurred more frequently in patients assigned to medical treatment. Irrespective of whether patients were catheterized initially or only after drug therapy failure, their survival rates were better if they were revascularized within the first year.