Heart Attack Care: Drugs vs. Stents
Analysis Shows Drugs After Heart Attack Are Effective and Reduce Costs
Feb. 18, 2009 -- Opening blocked arteries with balloon angioplasty and stents can save lives during a heart attack, but the invasive treatment offers little added value over heart drugs alone in patients first treated days and even weeks later.
Now a new analysis shows that avoiding stenting in stable late-presenting patients could result in a yearly savings of around $700 million in health care costs.
"What we have here is one of those cases where less is more," says researcher Daniel B. Mark, MD, MPH, of Duke University Medical Center.
Stents Most Useful Early
Clearing blocked arteries in the early stages of a heart attack can restore blood flow before heart muscle is permanently damaged.
But as many as a third of the roughly 1 million Americans who have heart attacks each year are treated more than 12 hours after their first symptoms appear, when heart damage is likely to have already occurred, Mark tells WebMD.
Clot-busting drugs are not an option when treatment is delayed, but bare metal or drug-coated metal stents were often implanted to prop open and clear blocked arteries in late-presenting patients, even when they had no angina (chest pain) or other physical symptoms.
In the Occluded Artery Trial (OAT), a major, federally funded study published two years ago, Mark and colleagues reported that late-presenting heart attack patients with blocked arteries had no better long-term outcomes when they were treated with balloon angioplasty and stents than when treated with drugs alone. These results led to major changes in the management of such patients by many cardiologists.
All of the patients enrolled in OAT were clinically stable with no chest pain, and all received appropriate medical treatment with drugs like aspirin, beta-blockers, ACE inhibitors, and statins.
Quality of Life and Treatment Costs
In a new report, published in the Feb. 19 issue of the New England Journal of Medicine, Mark and colleagues further analyzed the OAT data.
They examined quality-of-life measurements and treatment costs among the two treatment groups.
Quality of life was determined through standardized questionnaires administered either face-to-face or by telephone at enrollment and at 4, 12, and 24 months.