Heart surgery aids elderly with diabetes, angina

Elderly Diabetic patients with chronic heart-related Chest pain - Angina - benefit from surgery to open blocked coronary arteries to the same degree as similar heart patients without Diabetes, according to Swiss researchers.

As senior investigator Dr. Mathias E. Pfisterer said, "elderly patients and their physicians may choose either an invasive strategy ... or a medical strategy with a similar long-term outcome."

Each choice has it pros and cons, he pointed out. Heart surgery provides "early symptom relief and improvement in well-being," but involves considerable cost; on the other hand, medical management entails "more drugs and a greater than 50 percent chance of the need for late revascularization" - ie, surgery or angioplasty to restore bloodflow to the heart muscle.

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.

The team examined the difference in outcome over 4 years between the diabetic and nondiabetic patients, and reported the findings in the American Journal of Cardiology.

Compared with non-diabetics, people with Diabetes had more hypertension, risk factors, previous Heart failure and Heart Attacks. However, in both groups, the overall survival was 61 percent without revascularization, compared to 79 percent with revascularization.

Pfisterer also noted that cost analysis showed that the early increased costs of heart surgery are balanced by increased doctor's fees and late surgery costs 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, whether or not they have Diabetes.

SOURCE: American Journal of Cardiology, July 2005.