Angioplasty & Stents Post Heart Attack - This was a little unexpected. Study indicates that using angioplasty or inserting stents more than 25 hours after a heart attack does NOT increase survival rates.

Where's the logic in that?

This article doesn't attempt to explain--in fact, doctors are perplexed by the result--but the piece is still worth reading.

Late Use of Heart Stents May Not Help, Study Says

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November 14, 2006
Late Use of Heart Stents May Not Help, Study Says

Opening a blocked artery with balloons and stents can be lifesaving in the early hours after a heart attack, but a new study concludes that it often does no good if the heart attack occurred more than 25 hours ago.

The findings should change medical practice, researchers say, and may affect as many as 50,000 patients a year in the United States.

The researchers say that doctors should stop trying to open arteries in people who had heart attacks days or weeks ago and who are stable and free of chest pain. Currently, the balloon procedure, called angioplasty, is often used in those patients, along with stents, devices that are implanted to prop an artery open.

The new study “should change practice, and I believe it will,” said Dr. Judith S. Hochman, director of the cardiovascular clinical research center at New York University medical school, and leader of the study, which included 2,166 patients at 217 hospitals in the United States and other countries.

Dr. Hochman presented the results today at a meeting of the American Heart Association in Chicago. The results were also published online by The New England Journal of Medicine and will appear in its Dec. 7 issue.

This is an important study,” said Dr. Elizabeth G. Nabel, director of the National Heart, Lung, and Blood Institute, which helped pay for the research. “It’s definitive. The evidence from it should be weighed very carefully by the groups that formulate guidelines about when to conduct angioplasty in the setting of a heart attack.”

The Expert Guide to Beating Heart Disease: What You Absolutely Must Know

A million Americans a year have heart attacks, and half of them die as a result of the attacks, according to the National Heart, Lung, and Blood Institute. About a million angioplasties a year are performed in the United States, some in heart attack victims and some in people with blocked arteries who have not had heart attacks.

Dr. Hochman emphasized that angioplasty is still the best treatment for many heart-attack patients who get to the hospital early, within 12 hours of the onset of the attack. For them, opening a clogged artery — “early angioplasty” — can restore blood flow and reduce damage to the heart muscle. After 12 hours, however, it is too late to save the muscle.

Still, about one-third of heart attack patients show up at the hospital more than 12 hours after the attack began, and many doctors open their arteries anyway, thinking that doing so might still have long-term benefits. In that situation, the procedure is called late angioplasty; it can be helpful in people who are still suffering from chest pain or have certain other complications from the heart attack.

But what about people who show up late but are medically stable and free of chest pain? The new study tried to find out if late angioplasty could help them.

Although angioplasty is not open surgery, it is an invasive procedure, with risks, and the researchers wanted to know if there was any reason to put these patients through it when they already seemed to be on the road to recovery. The study showed there was no need for the procedure for them.

The findings may come as a rude surprise to many cardiologists, who have come to believe that opening up a blocked artery, even days or weeks after a heart attack, is bound to be good for patients.

Even Dr. Hochman was surprised by the results. She said she and her colleagues expected to find that angioplasty would reduce the risks of heart failure, subsequent heart attacks and death. But their theory failed the test.

This is why we have clinical trials,” she said.

She added that cardiologists were such strong believers in late angioplasty that some major medical centers in the United States and Europe had refused to participate in her study, insisting that it would be unethical to let some patients go without the procedure for comparison purposes.

The 2,166 patients in the study had all suffered heart attacks that were caused by a completely blocked coronary artery. They were in stable condition and free of chest pain, and were picked at random to receive either heart medicines only or balloon treatment and stents plus heart medicines, at times from 25 hours to 28 days after their heart attacks. The researchers then tracked their health for an average of three years.

There were no differences between the groups and how they fared. They suffered subsequent heart attacks, heart failure and death at essentially the same rates. If anything, those who had late angioplasty actually seemed to fare a bit worse than those who did not, but the differences were not statistically significant, and therefore might have been due to chance, Dr. Hochman said.

An expert not involved in the research, Dr. Steven E. Nissen, chairman of cardiovascular medicine at the Cleveland Clinic and president of the American College of Cardiology, said the study was independent and well-conducted.

Having an artery open ought to be good for you,” he said. “Why not open it late? Like a lot of things in medicine, however, when you actually test it in an organized way, in a randomized, controlled trial, you find out it doesn’t work.”

Dr. Nissen added, “It will change what I do.”

In an editorial accompanying the study in the journal, two other cardiologists write that balloons and stents may still be worthwhile even for some heart attack patients who, like those in the study, are stable and past the 12-hour window. The patients who might benefit, they say, are a small minority — perhaps 10 to 15 percent — who cannot take the class of heart medicines known as beta blockers, which have been shown to increase survival rates after heart attacks.

The Expert Guide to Beating Heart Disease: What You Absolutely Must Know
Dr. Dean Ornish's Program for Reversing Heart Disease: The Only System Scientifically Proven to Reverse Heart Disease Without Drugs or Surgery
TOTAL HEART HEALTH: How to Prevent and Reverse Heart Disease with the Maharishi Vedic Approach to Health

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