People with chronic chest pain who are not in big danger of a heart attack now may have even less reason to rush into an artery-opening angioplasty: There's more evidence that drugs should be tried first and often are just as effective.
The slim early advantage for angioplasty at relieving pain in these non-emergency cases starts to fade within six months and vanishes after three years, according to a new report from a landmark heart study.
That is sooner than the five years doctors had estimated last year after their first analysis of the study. The new information comes from patients' own reports of how they fared after treatment. The results are in today's New England Journal of Medicine.
"This study should be enlightening and practice-changing for doctors and patients alike" and should lead more patients to try drugs before having the $40,000 procedure, said Duke University's Dr. Eric Peterson, co-author of an editorial in the journal.
The number of angioplasties has been falling since the first results from this big study came out in 2007, according to new figures from the American College of Cardiology. The study was funded by the U.S. Department of Veterans Affairs, the Medical Research Council of Canada and a host of drug companies.
Angioplasty remains the top treatment for people who are having a heart attack or who have been hospitalized with worsening symptoms. It involves using a tiny balloon to flatten a clog and propping the artery open with a mesh tube called a stent.
However, at least one third of angioplasties are done on people not in imminent danger, to relieve chest pain. These patients are no more likely to die or suffer a heart attack if initially treated with drugs alone, the 2,287-patient study revealed.
Still, angioplasty's proponents tout it as a quick fix that improves quality of life. That benefit is fairly small and short-lived, compared with the benefits of using good medication alone, the new report found.
Researchers did followup surveys of about 70 percent of the study's participants. At the start, 78 percent had chest pain. Three months after treatment, 53 percent of patients who had angioplasties plus drug treatment and 42 percent of the drugs-alone patients were free of chest pain. Both groups continued to improve, and the gap started to narrow within six months. After three years, their scores rating chest pain, quality of life and treatment satisfaction did not significantly differ.
Those who started out with the more severe chest pain fared better with angioplasty.