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Heart Disease Health Center

Don't Wait to Treat Chest Pain

Early Intervention Beats Conservative Measures, Say Researchers
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Jan. 18, 2005 -- Taking the strongest possible steps against chest pain pays off, even when chest pain isn't severe, a study shows. That's the latest word in a long-running debate about treating chest pain in its early stages.

For patients, there's no question what chest pain means: a call to 911. After all, it's a classic heart attack symptom for men and women. True, chest pain doesn't always herald a heart attack, and heart attacks can occur without chest pain. But there's no reason to take a chance when life and death could be at stake.

2 Approaches to Chest Pain

One way to treat chest pain is with interventional strategies. That means looking inside blood vessels to see how they're holding up, then fixing any signs of trouble.

At the very least, that calls for angiography. In angiography,angiography, a thin, flexible tube is inserted into a blood vessel in the leg or arm and then guided to the trouble spot. Dye is injected to make the area more visible, and X-rays are taken.

Like any surgery, angiography has risks. So do the procedures that reopen blocked blood vessels.reopen blocked blood vessels. That's one reason why interventional strategies have usually been used in severe chest pain cases.

The conservative approach to treating chest pain favors medicine, using surgery only when the situation looks serious.

Comparing Strategies

What's the best option when chest pain is not severe? That's the question posed by researchers in the Jan. 18 issue of the Journal of the American College of Cardiology.

The scientists hailed from the U.K. They had already compared death and nonfatal heart attack with both approaches. The interventional strategy cut death and nonfatal heart attack risk four months after treatment, but after a year, the gap had closed.

Now, the researchers turned their attention to quality of life. They studied about 1,800 heart diseaseheart disease patients with early stages of chest pain. Their pain occurred at rest, and they'd already shown signs of heart disease.

Less Chest Pain, Better Quality of Life

Afterward, participants completed quality-of-life surveys. Topics covered physical function, emotions, sociability, pain, mental health, vitality, and general health.

Four months after treatment, quality of life was significantly higher for the interventional strategy group. Most of that was due to relief they'd gotten from their chest pain, say the researchers.

In time, the gap narrowed. A year after treatment, quality of life was still better for the interventional strategy patients, but the difference was smaller.

Some people in the conservative group may have switched tactics, taking interventional steps when their condition worsened, say the researchers. They say an early interventional strategy should be recommended to reduce the occurrence of chest pain and to possibly improve quality of life.

Still, surgery is more costly than medicine. The cost-benefit economics of chest pain treatment have yet to be done, the researchers note.

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