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To the Editor: Dr Pfisterer and colleagues¹ reported that 1 year after either invasive treatment or optimized medical therapy, elderly patients with angina had similar symptoms, quality of life, and risk of death or nonfatal myocardial infarction. In contrast with their previous report of 6-month outcomes,² the authors now report that patients who underwent medical therapy had a higher risk of later hospitalizations for uncontrolled symptoms. The end point of hospitalization seems reasonable, even though other primary and secondary prevention studies did not use it.^3-5 Although this makes the trial less comparable with previous results, the authors did not discuss these differences.

Furthermore, the authors' use of the term "optimized medical therapy" seems questionable. Only 22% of these patients received lipid-lowering drugs, and despite the fact that all had symptomatic coronary artery disease, 23% had diabetes and 45% had hypercholesterolemia. Ideal medical management would include achieving low-density lipoprotein cholesterol of . . . [Full Text of this Article]

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