FRINK Linked Data Fragments server

Matches in SemOpenAlex for { <https://semopenalex.org/work/W1995087355> ?p ?o ?g. }

• W1995087355 endingPage "354" @default.
• W1995087355 startingPage "354" @default.
• W1995087355 abstract "In their otherwise informative paper, the TIME investigators1The TIME InvestigatorsTrial on invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial.Lancet. 2001; 358: 951-957Summary Full Text Full Text PDF PubMed Scopus (395) Google Scholar enrolled 305 patients older than 75 years with chronic angina despite use of two or more antianginal drugs. Their data show that 79% of patients had disease in two or three coronary vessels, 14% had left main disease, and around half were hyperlipidaemic, had survived a previous acute myocardial infarction, or were hypertensive. Despite the fact that all patients were under medical care, only 22–25% received lipid-lowering drugs, 50% received calcium antagonists, and 23–35% received angiotensin-converting-enzyme inhibiting drugs. At 6 months' follow-up, 27% required assistance in completing quality-of-life forms, and 19% of forms were not completed.There was no mortality benefit in the short-term follow-up and the significant improvement in event-free survival was entirely related to a reduction in hospital admission for ischaemic symptoms. The death rate was twice as high in the invasive group, although not significantly so, because of the small number of events. Figure 2 in the study shows that time to death or non-fatal myocardial infarction was similar in both groups.The investigators use the term optimum medical therapy, yet no evidence is included to show that this was achieved. Optimum medical therapy would represent the achievement of ideal lipid values including a goal LDL-cholesterol lower than 100 mg/dL, a blood pressure of 130/80 mm Hg, and the discontinuation of the 31–37% of those who were currently smoking. Each of these goals is attainable in most optimally treated patients.The study clearly included many patients who required invasive treatment, certainly the 14% with left main disease and many of the 60% with triple-vessel disease have much to gain from invasive treatment. On the other hand the 7% of patients with no vessel disease and the 14% with single-vessel disease might have done equally well with truly optimum medical care, with no notable mortality or non-fatal myocardial infarction cost. Studies such as AVERT2Pitt B Waters D Brown U Eisenberg D for AVERT InvestigatorsAggressive lipid-lowering therapy compared with angioplasty in stable coronary disease.N Engl J Med. 1999; 341: 70Crossref PubMed Scopus (839) Google Scholar were referenced by the TIME investigators, in which the well known finding that there was a reduction in ischaemic events with lipid-lowering treatment, as was seen in the MIRACL3Schwartz GG Olsson AG Ezekowitz MD et al.for the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study InvestigatorsEffects of atorvastatin on early recurrent ischemic events in acute coronary syndromes—the MIRACL study—a randomized controlled trial.JAMA. 2001; 285: 1711-1718Crossref PubMed Google Scholar study, was not discussed. That many of these otherwise well described patients did not receive optimal medical management is unfortunate. In their otherwise informative paper, the TIME investigators1The TIME InvestigatorsTrial on invasive versus medical therapy in elderly patients with chronic symptomatic coronary-artery disease (TIME): a randomised trial.Lancet. 2001; 358: 951-957Summary Full Text Full Text PDF PubMed Scopus (395) Google Scholar enrolled 305 patients older than 75 years with chronic angina despite use of two or more antianginal drugs. Their data show that 79% of patients had disease in two or three coronary vessels, 14% had left main disease, and around half were hyperlipidaemic, had survived a previous acute myocardial infarction, or were hypertensive. Despite the fact that all patients were under medical care, only 22–25% received lipid-lowering drugs, 50% received calcium antagonists, and 23–35% received angiotensin-converting-enzyme inhibiting drugs. At 6 months' follow-up, 27% required assistance in completing quality-of-life forms, and 19% of forms were not completed. There was no mortality benefit in the short-term follow-up and the significant improvement in event-free survival was entirely related to a reduction in hospital admission for ischaemic symptoms. The death rate was twice as high in the invasive group, although not significantly so, because of the small number of events. Figure 2 in the study shows that time to death or non-fatal myocardial infarction was similar in both groups. The investigators use the term optimum medical therapy, yet no evidence is included to show that this was achieved. Optimum medical therapy would represent the achievement of ideal lipid values including a goal LDL-cholesterol lower than 100 mg/dL, a blood pressure of 130/80 mm Hg, and the discontinuation of the 31–37% of those who were currently smoking. Each of these goals is attainable in most optimally treated patients. The study clearly included many patients who required invasive treatment, certainly the 14% with left main disease and many of the 60% with triple-vessel disease have much to gain from invasive treatment. On the other hand the 7% of patients with no vessel disease and the 14% with single-vessel disease might have done equally well with truly optimum medical care, with no notable mortality or non-fatal myocardial infarction cost. Studies such as AVERT2Pitt B Waters D Brown U Eisenberg D for AVERT InvestigatorsAggressive lipid-lowering therapy compared with angioplasty in stable coronary disease.N Engl J Med. 1999; 341: 70Crossref PubMed Scopus (839) Google Scholar were referenced by the TIME investigators, in which the well known finding that there was a reduction in ischaemic events with lipid-lowering treatment, as was seen in the MIRACL3Schwartz GG Olsson AG Ezekowitz MD et al.for the Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study InvestigatorsEffects of atorvastatin on early recurrent ischemic events in acute coronary syndromes—the MIRACL study—a randomized controlled trial.JAMA. 2001; 285: 1711-1718Crossref PubMed Google Scholar study, was not discussed. That many of these otherwise well described patients did not receive optimal medical management is unfortunate. Invasive and medical therapy for coronary artery diseaseAuthors' reply Full-Text PDF" @default.
• W1995087355 created "2016-06-24" @default.
• W1995087355 creator A5013702307 @default.
• W1995087355 date "2002-01-01" @default.
• W1995087355 modified "2023-10-16" @default.
• W1995087355 title "Invasive and medical therapy for coronary artery disease" @default.
• W1995087355 cites W2160152341 @default.
• W1995087355 cites W2315638360 @default.
• W1995087355 cites W2400512890 @default.
• W1995087355 doi "https://doi.org/10.1016/s0140-6736(02)07513-x" @default.
• W1995087355 hasPubMedId "https://pubmed.ncbi.nlm.nih.gov/11830230" @default.
• W1995087355 hasPublicationYear "2002" @default.
• W1995087355 type Work @default.
• W1995087355 sameAs 1995087355 @default.
• W1995087355 citedByCount "0" @default.
• W1995087355 crossrefType "journal-article" @default.
• W1995087355 hasAuthorship W1995087355A5013702307 @default.
• W1995087355 hasBestOaLocation W19950873551 @default.
• W1995087355 hasConcept C126322002 @default.
• W1995087355 hasConcept C164705383 @default.
• W1995087355 hasConcept C179755657 @default.
• W1995087355 hasConcept C2778213512 @default.
• W1995087355 hasConcept C2778425758 @default.
• W1995087355 hasConcept C2779134260 @default.
• W1995087355 hasConcept C500558357 @default.
• W1995087355 hasConcept C71924100 @default.
• W1995087355 hasConceptScore W1995087355C126322002 @default.
• W1995087355 hasConceptScore W1995087355C164705383 @default.
• W1995087355 hasConceptScore W1995087355C179755657 @default.
• W1995087355 hasConceptScore W1995087355C2778213512 @default.
• W1995087355 hasConceptScore W1995087355C2778425758 @default.
• W1995087355 hasConceptScore W1995087355C2779134260 @default.
• W1995087355 hasConceptScore W1995087355C500558357 @default.
• W1995087355 hasConceptScore W1995087355C71924100 @default.
• W1995087355 hasIssue "9303" @default.
• W1995087355 hasLocation W19950873551 @default.
• W1995087355 hasLocation W19950873552 @default.
• W1995087355 hasOpenAccess W1995087355 @default.
• W1995087355 hasPrimaryLocation W19950873551 @default.
• W1995087355 hasRelatedWork W1971345608 @default.
• W1995087355 hasRelatedWork W2035030275 @default.
• W1995087355 hasRelatedWork W2049397185 @default.
• W1995087355 hasRelatedWork W2083251056 @default.
• W1995087355 hasRelatedWork W2085050035 @default.
• W1995087355 hasRelatedWork W2135975603 @default.
• W1995087355 hasRelatedWork W2237746437 @default.
• W1995087355 hasRelatedWork W2399063111 @default.
• W1995087355 hasRelatedWork W2417414779 @default.
• W1995087355 hasRelatedWork W2790353319 @default.
• W1995087355 hasVolume "359" @default.
• W1995087355 isParatext "false" @default.
• W1995087355 isRetracted "false" @default.
• W1995087355 magId "1995087355" @default.
• W1995087355 workType "article" @default.