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August 28, 1996

Treatment Strategies for Patients With Ischemic Chest Pain

Author Affiliations

Hospital of the University of Pennsylvania Philadelphia

JAMA. 1996;276(8):606. doi:10.1001/jama.1996.03540080028019

To the Editor.  —Dr Stone and colleagues1 report findings from their study designed to investigate the natural history and treatment of patients with unstable angina or non—Qwave myocardial infarction (MI). In their conclusions, the investigators suggest that "more aggressive strategies should be directed to those patients with the greatest likelihood of adverse outcomes." Although this conclusion generally makes logical clinical sense (ie, women with angina or MI), the investigators have taken a giant leap in extending this conclusion to elderly patients without further investigation.This study showed that elderly patients received significantly less aggressive medical management, underwent fewer angiographic procedures and revascularizations, and experienced more severe outcomes. It is possible, as the authors suggest, that elderly patients and their families refuse aggressive procedures and therapy or that invasive procedures are offered to the elderly less often because of coexisting morbidities.It seems only logical that, before we can suggest