Despite increased risk of complications, invasive testing in elderly patients improves outcomes after a heart attack, according to a study recently presented at the American College of Cardiology’s 64th Annual Scientific Session in San Diego.
Also published in the New England Journal of Medicine, this study tested the use of coronary angiography in heart attack patients over 80 years old. Coronary angiography is a common medical test that uses dye and X-rays to find out if the heart’s arteries are blocked or narrowed. Although coronary angiography is generally safe, risk of complications is higher in older patients, which may deter doctors from performing such tests on them.
To determine whether the benefits outweigh the risks, researchers randomly assigned 458 elderly patients with chest pain or heart attack to one of two groups. Half of patients underwent coronary angiography testing to assess the heart and determine the best course of treatment. The other half were prescribed conservative therapy to reduce cardiovascular risk, without undergoing any invasive testing.
After one and a half years of follow up, researchers found that patients receiving the invasive procedure had significantly lower risk of death, heart attack, stroke and urgent heart procedures than those bypassing such testing. The take home message, as authors explain, is that more conservative therapy isn’t necessarily the best option in older patients experiencing chest pain or heart attack.
“Because people over 80 are underrepresented in clinical trials, they are less likely to receive treatment according to guidelines,” said Nicolai Tegn, MD, the study’s lead author. “Our study, which directly targets the over-80 population, is the first to demonstrate that a more invasive strategy results in better outcomes in these patients.”
In patients experiencing chest pain or heart attack, coronary angiography provides important, detailed information that is crucial to determining the best possible treatment. Although more research is needed to better understand the role of invasive testing in older patients, findings suggest that the benefits of such testing far outweigh the risks.