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Fundamental Changes for Invasive Cardiology?

Discussion in 'Medical Students - MD' started by OncoCaP, Mar 26, 2007.

  1. OncoCaP

    OncoCaP 2+ Year Member

    2,016
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    Aug 28, 2006
    Houston, Texas
    MDApps:
    I wonder if we will be seeing less invasive cardiology procedures than we would have otherwise (say number of stents per number of people over 60):

    http://www.chron.com/disp/story.mpl/health/4663717.html
    (also: http://www.cnn.com/2007/HEALTH/conditions/03/26/stents.vs.drugs.ap/index.html)
    NEW ORLEANS — More than half a million people a year with chest pain are getting an unnecessary or premature procedure to unclog their arteries because drugs are just as effective, suggests a landmark study that challenges one of the most common practices in heart care.

    The stunning results found angioplasty did not save lives or prevent heart attacks in non-emergency heart patients.

    An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done.

    "By five years, there was really no significant difference" in symptoms, said Dr. William Boden of Buffalo General Hospital in New York. "Few would have expected such results."

    ...
    "Even though it goes against intuition, the blockages that are severe that cause chest pain are less likely to be the source of a heart attack than segments in the artery that are not severely blocked," said Dr. David Maron, a Vanderbilt University cardiologist who helped lead the new study.

    The procedure already has lost some popularity because of emerging evidence that popular drug-coated stents can raise the risk of blood clots months later. The new study shifts the argument from which type of stent to use to whether to do the procedure at all.

    It involved 2,287 patients throughout the U.S. and Canada who had substantial blockages, typically in two arteries, but were medically stable. They had an average of 10 chest pain episodes a week — moderately severe. About 40 percent had a prior heart attack.

    "We deliberately chose to enroll a sicker, more symptomatic group" to give angioplasty a good chance to prove itself, Boden said.

    All were treated with medicines that improve chest pain and heart and artery health such as aspirin, cholesterol-lowering statins, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers. All also were counseled on healthy lifestyles — diet, exercise and smoking cessation. Half of the participants also were assigned to get angioplasty.

    After an average of 4 1/2 years, the groups had similar rates of death and heart attack: 211 in the angioplasty group and 202 in the medication group — about 19 percent of each.

    Heart-related hospitalization rates were similar, too.

    Neither treatment proved better for any subgroups like smokers, diabetics, or older or sicker people.

    At the start of the study, 80 percent had chest pain. Three years into it, 72 percent of the angioplasty group was free of this symptom as was 67 percent of the drug group. That means you would have to give angioplasties to 20 people for every one whose chest pain was better after three years — an unacceptably high ratio, Nissen said.
     
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