Monday, March 26, 2007

Drugs may be just as good as surgery for clogged arteries

By Stephen Smith and Liz Kowalczyk, Globe Staff

Patients with clogged arteries who have not yet had a heart attack benefit just as much from medications as angioplasty, according to a study released today.

Specialists representing different camps in cardiology have long argued about the best way to handle patients who have potentially life-threatening narrowing of arteries. Decisions about how to treat heart disease, the nation's number one killer, have significant ramifications, medically and economically.

A large team of researchers from across North America, who presented their findings today at the American College of Cardiology's annual meeting in New Orleans, studied nearly 2,300 patients suffering coronary artery disease.

"The results are very striking," said Dr. Steven Nissen, chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic. "This is important for patients because it does now mean patients have choices. If your symptoms aren't so severe and aren't interfering with your lifestyle, you can afford to wait."

Half of the patients took medication and underwent angioplasty, a procedure that involves using a tiny balloon and metal scaffolds called stents to prop open arteries. The other half received only medication, including drugs to lower cholesterol, relax blood vessels, slow heart rate, and prevent blood clots.

After tracking the patients for an average of four-and-a-half years, in a trial nicknamed COURAGE, the team, including some scientists from Connecticut, found that there was no difference in outcomes between the groups.

The study should help patients and doctors make sure they're using angioplasty for the right reasons, said Dr. William Maisel, a cardiologist at Beth Israel Deaconess Medical Center.

"To place a stent to reduce the chances of a heart attack or to prevent someone from dying, those are not reasons to put in a stent," Maisel said.

The study, to be published in the New England Journal of Medicine, found that among patients experiencing angina -- chest pain that occurs when the heart muscle doesn’t get enough blood -- angioplasty provided more relief than drugs.

The report does not address how well angioplasty helps heart attack patients. Nissen said that angioplasty remains the treatment of choice for patients with a fully blocked artery, and that campaigns are underway to make sure patients having heart attacks are taken to hospitals that can swiftly perform the procedure.

"COURAGE helps us understand we may well have gone too far with angioplasty and that we may have abandoned bypass surgery too quickly," said Nissen, who was not involved in the study. Bypass surgery, in which a surgeon reroutes, or "bypasses," blood around clogged arteries, is more complicated and has a longer recovery time than angioplasty.

In Boston, because of the conservatism of local doctors, the rate of angioplasty is lower than it is nationally, according to Dr. Frederic S. Resnic, director of the cardiac catheterization laboratory at Brigham and Women's Hospital.

At the Brigham, he wrote in an e-mail, "We have always been very careful to have detailed discussions with our patients with stable coronary artery disease, to make sure that they are comfortable and understand that we are considering the procedure to relieve the
symptoms of angina, and reduce the number and amount of medications needed.

"We have also been careful to say that angioplasty has not been shown to reduce heart attacks or prolong life in these very stable patients," he wrote. "Angioplasty for stable patients is really an effective option for relieving symptoms quite completely; but should not be "sold" to patients as a life-saving procedure."

Posted by Karen Weintraub at 02:02 PM

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