Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
In Reply: In response to Dr Nash, the TIME
study was intended to mirror the actual clinical situation of elderly patients
coming to their physician with chest pain despite "standard" drug therapy.
When the patient asks for less pain (ie, a better quality of life), what should
be offered? To answer this question, we randomized these patients based on
their clinical presentation and not on angiographic findings. Of course, patients
randomized to the invasive strategy without significant disease did not undergo
revascularization, and those with left main artery disease did if it was technically
possible. It would not have been appropriate, however, to have excluded these
patients from the analysis, as some patients in the medical-treatment group
would have been found to have similar results if they had undergone angiography.
Of course, it was impossible to identify those individuals, who were therefore
included in the analysis. The only alternative would be to perform coronary
angiograph in all patients aged 75 years or older with angina.
Pfisterer M. Outcomes of Medical vs Invasive Therapy for Elderly Patients With Angina—ReplyOutcomes of Medical vs Invasive Therapy for Elderly Patients With Angina—Reply. JAMA. 2003;289(21):2794. doi:10.1001/jama.289.21.2794-a