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Heart Strategy: Angioplasty vs. Drugs

Study Shows Angioplasty May Prevent Second Heart Attacks in Symptom-Free Patients
By
WebMD Health News
Reviewed by Louise Chang, MD

May 8, 2007 -- Opening blocked arteries with angioplasty is more effective than drugs for preventing second heart attacks in some heart attack survivors, according to a 10-year follow-up study from Switzerland.

The newly reported study included 201 heart attack survivors with documented heart vessel blockage but no chest pain or other symptoms. One group was treated with angioplasty and drugs; the other group had intensive drug therapy only.

A decade later, 67 of the 105 drug-treated patients had suffered another major cardiac event, compared with 27 of the 96 patients who had angioplasty.

Researchers say the findings show that later angioplasty is an important preventive strategy for preventing second heart attacks in asymptomatic patients.

The study appears in the May 8 issue of TheJournal of the American Medical Association.

"We found a consistent benefit for this intervention in patients who did not have chest pain or other symptoms [indicative of vessel blockage]," researcher Paul Erne, MD, tells WebMD.

The New Findings

Though the patients in the study did not have chest pain or other symptoms, they did have heart monitor abnormalities consistent with artery blockage confirmed through exercise stress tests. Their heart attacks had occurred within three months of enrolling in the trial.

All were treated with either angioplasty and drugs or intensive drug therapy only between May 1991 and March 1997; follow-up continued until late May 2006.

None of the angioplasty patients had stenting; the procedure was not standard practice at that time.

Patients in both arms of the trial took aspirin, cholesterol-lowering statins, and blood pressure medications.

During an average of 10.2 years of follow-up, 64% of the patients treated with drugs alone and 28% of those treated with angioplasty experienced major cardiac events. Seven drug-treated patients and one angioplasty-treated patient died of cardiac causes during the follow-up.

American Heart Association (AHA) spokesman Sidney C. Smith, MD, calls the findings intriguing, but he tells WebMD that the study is far too small to prove the value of angioplasty over drugs for asymptomatic heart patients.

He adds that major advances in both angioplasty and drug therapies for heart disease in the 10 to 15 years since the patients in the study were treated further complicate the interpretation of the findings.

Smith is director of the Center for Cardiovascular Science and Medicine at the University of North Carolina, Chapel Hill and a past president of the AHA.

"A larger study comparing contemporary [drug] treatments to contemporary angioplasty with stenting could tell us if these findings hold up," Smith says.

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