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June 4, 2003

Outcomes of Medical vs Invasive Therapy for Elderly Patients With Angina—ReplyOutcomes of Medical vs Invasive Therapy for Elderly Patients With Angina—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;289(21):2794. doi:10.1001/jama.289.21.2794-a

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.

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