Angioplasty: Timing Is Key to Success
Study Shows Later Treatment May Not Help Some Heart Attack Patients
Nov. 14, 2006 (Chicago) -- There may be a relatively narrow time frame for doctors to use angioplasty and a stent to open the blocked arteries of heart attack patients.
A study shows that when used three to 28 days after a major heart attack, the procedure did not reduce the risk of having another heart attack, developing heart failure, or dying.
For certain heart attack victims, "there is no benefit to opening the artery late," says researcher Judith Hochman, MD, clinical chief of cardiology at New York University School of Medicine in New York City.
The findings were posted online by The New England Journal of Medicine to coincide with Hochman's presentation at the annual meeting of the American Heart Association (AHA).
Angioplasty vs. Drug Therapy
Opening blocked arteries with angioplasty plus stenting in the first 12 hours after a major heart attack is known to reduce further damage and improve the chance of survival.
But many U.S. doctors perform the procedure outside the recommended time frame, despite the lack of evidence from large, well-designed studies, says Gervasio Lamas, MD, director of Cardiovascular Research and Academic Affairs at Mount Sinai Medical Center in Miami and moderator of the session.
To find out whether this is good medicine, Hochman and colleagues studied 2,166 people who had 100% blockage in one of the three major heart arteries and were stable three to 28 days after their heart attack.
The participants were randomly assigned to receive either angioplasty plus stenting with medication, or medication alone.
By an average of three years later, 17.2% of people in the angioplasty group had another heart attack, developed heart failure, or died, compared with 15.6% of those in the medication group, a difference so small it could have been due to chance.
When each of those events was looked at separately, there was "a concerning trend" toward more repeat nonfatal heart attacks in the angioplasty group: 6.9% vs. 5% in the medication-only group, Hochman says. But the numbers were small, so this again could have been due to chance.
"Death rates and heart failure rates were exactly the same between the two groups," she adds.