Coronary artery bypass surgery is better at relieving angina and improving functional abilities in the elderly than angioplasty or drug treatment, according to a presentation at the annual meeting of the American College of Cardiology. The study involved analysis of records on more than 1,000 patients (average age 76 years) who had been diagnosed and treated for significant coronary artery disease at a single American university medical center.

The researchers said their findings should help provide further guidance for elderly patients and their physicians in making treatment decisions for coronary artery disease. The presentation cited statistics that show the average American 75-year-old has an average of 10.9 additional years of life --- making decisions regarding cardiovascular quality of life clinically important.

"For many elderly patients, it is just as important to have a good quality of life as it is to have a prolonged quantity of life," said Karen Alexander, M.D., study presenter. "There are many elderly patients with the capacity to withstand procedures and enjoy a sustained functional improvement.

"The treatment choices were determined by the patients and doctors; but after taking into account other possible factors, we found that coronary artery bypass surgery still affords elderly patients better angina relief and functional outcomes after one year without excess mortality," she added.

In the current analysis, records were evaluated for 1,058 patients over the age of 70 years (average age, 76 years) who were diagnosed with significant coronary artery disease on cardiac catheterization. Of the patients studied, 41 percent received an angioplasty, 22 underwent surgery, and 37 were placed on medical therapy.

Patients answered questionnaires both before treatment began and 1 year later. These questionnaires yielded insight into how patients perceived their health status, functional abilities, and anginal symptoms. Taken together, the researchers concluded the results were a good indicator of how patients perceived quality of life.

"Patients who underwent bypass surgery reported less angina, higher health utility rates and better physical functioning after 1 year," Alexander said. "Even after adjusting the analysis for such factors as age, gender, education and other coexisting medical conditions, bypass surgery remained a significant predictor of better 1-year functioning."

Angina patients who received bypass operations reported an improvement from 47 percent to 13 percent after surgery, whereas angioplasty patients reported improvement from 47 percent to 23 percent. Improvement in overall quality of life was least for patients treated with drugs ---- with improvement from 49 percent to 26 percent.

On a scale of 1 to 100, bypass patients saw an increase in health utility scores from 62 to 70, compared with much smaller improvements in patients treated with angioplasty (from 65 to 67) or medications (from 61 to 63). Physical function scores improved for patients treated with either bypass (from 56 to 65) or medication (from 44 to 51) group, but remained unchanged (at 54) in the angioplasty group.

"Taken together, these findings will give both elderly patients and their physicians additional information as they weigh the potential risks and benefits of a potential treatment option," Alexander said. "Patients and physicians should take a broad view when considering these treatments, taking into account not only the medical aspect of treatment, but the likely level of independence and functional abilities afterward."