Late Angioplasty May Be Pointless

A new study suggests that angioplasty to open a blocked artery three to 28 days after a heart attack may be futile at best, and might even be harmful.

Researchers from New York University School of Medicine (NYU, NY, USA) and other academic institutions enrolled 2,166 people in 27 countries to receive either angioplasty three to 28 days after their heart attack and standard drug treatment--medicines to lower blood pressure and cholesterol, and aspirin and other anti-clotting drugs--or medicines alone. These were patients who had survived their original heart attack but had a single vessel completely blocked yet were stable because the heart was still receiving sufficient blood and oxygen from other vessels.

Four years later, 17% of those given angioplasty and drugs and nearly 16% of those given drugs alone had either died, suffered another heart attack, or developed heart failure, results considered to be statistically the same. There was an alarming trend toward more heart attacks in the angioplasty group (7% versus 5%) as time went on, although the researchers say this could have been a statistical fluke. The lack of benefit from angioplasty was not because the procedure did not work--it successfully reopened arteries more than 90% of the time. Instead, the findings suggested that once a blocked vessel had caused a heart attack, opening it was no better than taking standard medications for preventing future problems. The results of the study, led by Dr. Judith Hochman, cardiovascular research chief at NYU, were published in the December 7, 2006, issue of the New England Journal of Medicine.

"These findings were really a surprise,” said Dr. Elizabeth Nabel, director of the U.S. National Heart, Lung and Blood Institute (Bethesda, MD, USA). "For a long time we thought that opening up the artery any time after a heart attack was better than leaving it closed. My guess is you may see some guideline recommendations.”



Related Links:
New York University School of Medicine
U.S. National Heart, Lung and Blood Institute