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Angioplasty or stent surgery may provide more short-term relief for some patients that suffer from chronic chest pain. The advantages for angioplasty at relieving pain in these cases tend to fade over the years and vanish after three years, according to a new report from a landmark heart study published in the New England Journal of Medicine.
Researchers assessed 2,287 volunteers in 50 U.S. and Canadian medical centers as part of a study called COURAGE, for Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation. Stents provided patients an “incremental” benefit in reduced pain and fatigue after surgery, which by three years was equaled using anti-cholesterol drugs with an exercise and diet plan, the study said.
“This study should be enlightening and practice-changing for doctors and patients alike,” and should lead more to try drugs before resorting to the $40,000 heart procedure, said Duke University’s Dr. Eric Peterson, in an editorial. It’s estimated that several hundred thousand of surgeries of this type are performed each year in the United States.
In March 2007, the same researchers found that drug therapy performed equally well in preventing heart attacks and deaths in the same group of 2,287 patients.
European studies found that newer stents combined with drugs to reduce scarring in arteries might raise the risk of deadly clots.
“Patients get better,” regardless of which initial treatment they have, said study leader Dr. William Weintraub of Christiana Care Health System in Newark, Del. After three months of treatment, 53 percent of patients who had angioplasties combined with drug treatment and 42 percent of the drugs-alone patients were free of chest pain. The difference narrowed at six months and had all but vanished by three years.
“What we can say is that it’s safe to defer PCI,” researchers said. “We can also say that for people with severe angina, it’s quite reasonable to do more quick intervention.” Angioplasty remains the top treatment for people having a heart attack or hospitalized with worsening symptoms. About 1 million angioplasties are done in the United States each year. For every 1,000 patients treated with PCI first, they said, approximately two would die, 28 would have a heart attack associated with the surgery, 60 to 90 would do better, and at least 800 would see no difference compared to drug treatment.
The study was funded by the U.S. Veterans Affairs Department and the Canadian government. A third report, due in September, will weigh the economic costs and benefits of stent use, Weintraub said.
Researchers concluded that angioplasty is a safe and effective treatment for patient who have frequent or lifestyle-limiting angina while on medical therapy. “The greater the frequency of angina, the greater the benefit of PCI versus medical therapy alone, although less symptomatic patients can be well managed,” Donald Baim, Boston Scientific’s chief medical and scientific officer said in a statement.
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