Treatment of Stable Angina: Medical and Invasive Therapy—Implications for the Elderly

Currently available therapies for chronic stable angina are reviewed. Revascularization, i.e., coronary artery bypass surgery and percutaneous transluminal coronary angioplasty, is summarized briefly, with short- and long-term results summarized from several large registries and review articles. Advancing age is a risk factor for both coronary artery bypass surgery and percutaneous transluminal coronary angioplasty, but risks of coronary events are also higher without interventions in the elderly. In-hospital mortality for coronary artery bypass surgery is about 8% for patients over age 80 in one large national registry and not much different in elective coronary artery bypass surgery in highly-selected patients over age 90 in one institution. The few randomized trials of invasive vs. noninvasive therapy for stable coronary artery disease are described. Although patient numbers in available studies are too small to be conclusive as to which type of therapy is generally better, data appear to suggest that higher-risk patients have better outcomes with revascularization. Methods of risk stratification are discussed. Finally, unusual therapies for angina are briefly noted, including transmyocardial revascularization, external counterpulsation, and gene therapy.