Angioplasty favored over drug treatment
Angioplasty is significantly better than intensive drug treatment for patients who have had a heart attack and still have partially blocked arteries that impair blood flow to the heart but do not cause symptoms, Swiss researchers reported today.
Reopening the arteries with angioplasty reduced the risk of death or hospitalization by two-thirds over a 10-year follow-up period, the team reported in the Journal of the American Medical Assn.
Cardiologists have suspected that angioplasty was better for such patients, said Dr. John Warner of the University of Texas Southwestern Medical Center.
“But the big surprise here is that the number of cardiac deaths decreased significantly. That’s something that is unexpected,” said Warner, who was not involved in the study.
The findings are the opposite of recently reported results, which showed that intensive drug therapy is at least as good as angioplasty in patients with heart disease who have not had a heart attack.
But the patients in the Swiss study were at higher risk of death or repeat heart attacks. Warner said cardiologists knew that such patients “tend to do better when they are managed intensively.”
The results would probably apply to about a quarter of the 900,000 U.S. patients who have a heart attack each year, he said.
Dr. Paul Erne of the Kantonsspital Luzern in Switzerland and his colleagues at two other hospitals studied 201 patients who had suffered a heart attack and had so-called silent ischemia, in which blood flow to the heart is reduced but the patient does not feel pain. It is detected by stress tests -- in this case by monitoring the patients’ EKGs while they were riding an exercise bicycle.
All of the patients were daily given aspirin and a cholesterol-lowering statin; 96 of them underwent angioplasty -- without the insertion of stents to prevent plaque from accumulating again.
The remainder were put on a standard drug regimen to maintain heart health, including medicines to lower blood pressure and slow heart rate.
There were 27 deaths or hospitalizations in the group undergoing angioplasty and 67 deaths in the group receiving drugs, the team reported.
Only 11.6% of the patients who underwent angioplasty had subsequent ischemia, compared with 28.9% of those receiving drugs. And the angioplasty patients’ hearts continued to pump strongly, while those in the drug group lost strength.
Warner speculated that the results would have been better if the angioplasty patients had received stents -- tiny mesh devices that are inserted into arteries to keep them open. Stents were not widely available when the initial phase of the study was conducted.
The study was funded by the Swiss Heart Foundation, and the researchers received funding from pharmaceutical companies.
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