Heart Study: Most Angioplasties Not Needed

(CBS/AP)  More than half a million people a year with chest pain are getting an unnecessary or premature procedure to unclog their arteries because drugs are just as effective, suggests a landmark study that challenges one of the most common practices in heart care.

The stunning results found that angioplasty did not save lives or prevent heart attacks in non-emergency heart patients.

An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done.

"By five years, there was really no significant difference" in symptoms, said Dr. William Boden of Buffalo General Hospital in New York. "Few would have expected such results."

He led the study and gave results Monday at a meeting of the American College of Cardiology. They also were published online by the New England Journal of Medicine and will be in the April 12 issue.

Researchers from Canada and the United States followed more than 2,200 patients who had symptoms of heart disease but were considered stable, reports CBS News medical correspondent Dr. Jon LaPook. Half of these low-risk patients received stents and medication. The other half were given only medication: drugs to lower cholesterol, control blood pressure and prevent clotting.

To the surprise of the researchers, both groups fared about the same: approximately 19 percent had a heart attack or died within seven years, adds LaPook.

Angioplasty remains the top treatment for people having a heart attack or hospitalized with worsening symptoms. But most angioplasties are done on a non-emergency basis, to relieve chest pain caused by clogged arteries crimping the heart's blood supply.

Those patients now should try drugs first, experts say. If that does not help, they can consider angioplasty or bypass surgery, which unlike angioplasty, does save lives, prevents heart attacks and gives lasting relief of chest pain.

In the study, only one-third of the people treated with drugs ultimately needed angioplasty or a bypass.

"You are not putting yourself at risk of death or heart attack if you defer," and considering the safety worries about heart stents used to keep arteries open after angioplasty, it may be wise to wait, said Dr. Steven Nissen, a Cleveland Clinic heart specialist and president of the College of Cardiology.

Why did angioplasty not help more?

It fixes only one blockage at a time whereas drugs affect all the arteries, experts said. Also, the clogs treated with angioplasty are not the really dangerous kind.

"Even though it goes against intuition, the blockages that are severe that cause chest pain are less likely to be the source of a heart attack than segments in the artery that are not severely blocked," said Dr. David Maron, a Vanderbilt University cardiologist who helped lead the new study.

About 1.2 million angioplasties are done in the United States each year. Through a blood vessel in the groin, doctors snake a tube to a blocked heart artery. A tiny balloon is inflated to flatten the clog and a mesh scaffold stent is usually placed.

The procedure already has lost some popularity because of emerging evidence that popular drug-coated stents can raise the risk of blood clots months later. The new study shifts the argument from which type of stent to use to whether to do the procedure at all.

About 40 percent of patients in the study had a prior heart attack more than three months previously.

"We deliberately chose to enroll a sicker, more symptomatic group" to give angioplasty a good chance to prove itself, Boden said.

All were treated with medicines that improve chest pain and heart and artery health such as aspirin, cholesterol-lowering statins, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers. All also were counseled on healthy lifestyles — diet, exercise and smoking cessation.

Half of the participants also were assigned to get angioplasty.

After an average of 4½ years, the groups had similar rates of death and heart attack: 211 in the angioplasty group and 202 in the medication group.

Heart-related hospitalization rates were similar, too.

Neither treatment proved better for any subgroups like smokers, diabetics, or older or sicker people.

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[drinuk]

We have gotten to the stage when we can no longer believe anything from the medical profession especially from Big Pharma. Too many vested interests, Too many people taking "Graft" and "Backhanders" and far too much mis-information. Time as come for every doctor to write out a thousand times, "First Do No Harm" when they truly understand their oath we may be getting somewhere. As for the Pharmaceuticals, disciples of Bin Laden, all of them. Al Capone was a Saint compared to them.

[bobfishinguy]

Thank you Dr. Sero5, are you a moron or what?

If a doctor is considering an angioplasty you are way beyond the "diet and excersise" stage.

This is an insurance company study so they can save money by refusing to pay for angioplasties. Or maybe a drug company study to sell more drugs.

You dopes believe anything you read. The most important fact determining the results of a study - WHO PAID FOR IT, is not in the story.

[pwrslm]

"An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done.

"By five years, there was really no significant difference" in symptoms, said Dr. William Boden of Buffalo General Hospital in New York. "Few would have expected such results." "

Five years in slight and temporary? Whoever made that statement is in the closet. I want another opinion, made by someone whose head space stays on this side of common sense.

[me4prezz]

I agree that a healthier lifestyle will, in most cases, make the decision about needing an angioplasty and/or stenting a null issue, but there are those for whom dieting and exercising are just not enough and that is a little thing called genetics. It has been proven, and is scientific, that genetics can play a role in the amount of plaque that deposits in arteries, hypercholesteremia, hyperlipidemia, and/or hypertension, etc. Diabetes can also play a role as well as many other things.

While angioplasty with/without stenting may not be the best route and medications a better option, it is not an issue about how to steal money from patients for most physician and hospitals. I won't say all because in any business, you are going to have the few who ruin the reputation for all. But for many, who put in the years and years of school, internship, residency, more years in specializing and the hundreds of thousands in student loans, they do it because they genuinely and truly love and enjoy what they do and that they can help their patients. When new studies come out, they learn from them and take that and do what is best for the patient. Even in this article, they said that they were surprised at the results and so this will spread around and the cardiologists and cardiothoracic surgeons will find new and better ways to help. Do not write them all off as being money grubbers, especially when you need them later in life.

[obiwan234]

After four heart attacks in a month, my Cardiac surgeon flat out told me that putting in stents was not going to do me any good at all, so I had a 4 way by-pass in January. I'm glad I did and yes, I'm changing lifestyle issues to ensure a longer life, already lost 30 pounds.

[sero5]

All these unnecessary angioplastys are for one reason: $$$$$$$. Bilk as much as you can out patients and insurance. The most cost effective solution for people to avoid clogged arteries is a healthy diet and lifestyle. Exercise, exercise, exercise.