Pricking the Angioplasty Balloon
From the annual American Heart Association meeting in Chicago: Part four in a series of web-exclusive articles
About a third of heart-attack patients don't get angioplasty to reopen their blocked coronary artery for days or weeks, let alone within the recommended 90 minutes. Their heart-attack symptoms may have been insufficiently severe to prompt them to go to the hospital at all, or the attack may have caused a serious fall or other accident that takes priority if death seems unlikely. Studies done more than 20 years ago have led many doctors to believe that it's never too late to open a blocked coronary arteryso, long after their heart attack, patients often find themselves heading for the catheterization laboratory.
But that long-held belief is wrong, says a study presented at this week's heart meeting and published online Tuesday in the New England Journal of Medicine.
Researchers at hospitals in the United States and abroad divided 2,166 patients, all with a coronary artery that was totally blocked three to 28 days after a heart attack, into two groups. Both got a full array of appropriate medications, such as beta blockers and ACE inhibitors. One group also received angioplasty to open the blocked artery and a stent to keep it open. Then both groups were followed for four years. The patients who'd had angioplasty did not fare better. In fact, they had a slightly higher rate of death, additional heart attacks, and heart failure.
The silver lining to the news, according to an accompanying editorial, is that skipping angioplasty eliminates the need for coronary angiography after a heart attack, in which dye is squirted into the coronary arteries to identify a blocked vessel. That is often done routinely, and while generally very safe, it does carry a small risk of stroke or damage to a blood vessel.
The best medicine for keeping patients alive after a heart attack, the study found, is a beta blocker. Since 85 percent to 90 percent of patients can tolerate this inexpensive drug, that is welcome news indeed.