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
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
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.
New Time Frame Recommended
The findings surprised the researchers, who went into the study thinking
that opening up a blocked artery three to 28 days after the heart attack would
cut the risk of death, development of severe heart failure, or another heart
attack by 25%.
"It was logical that an open artery would be better than a closed
one," Hochman says. "But sometimes logical doesn't prevail. And until
this study was done, we didn't know this was an unnecessary procedure for the
type of patient we studied."
Hochman says she hopes the findings will dissuade doctors from performing
angioplasty outside the recommended time frame.
"It's certainly reason to rethink late angioplasty in stable patients
after an acute heart attack," agrees Timothy Gardner, MD, medical director
of the Center for Heart and Vascular Health at Christiana Care Health Services
in Wilmington, Del., and chairman of the AHA committee that chose which studies
to highlight at the meeting.