Study: Drugs trump angioplasty for chest pain

Updated 3/27/2007 3:29 PM

By Steve Sternberg, USA TODAY

NEW ORLEANS — Thousands of people with crushing chest pain who once opted for angioplasty as a quick fix may change their minds based on a landmark study out Monday showing that medication costs less, poses fewer risks and works just as well.

"I think this will change the discussion between the patient and doctor," says Raymond Gibbons of the Mayo Clinic and president of the American Heart Association. "In some cases it will lead to a decision not to use angioplasty and a stent."

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The study of 2,287 heart patients with chronic but stable chest pain is the first to show that taking medication alone is as effective as coupling medicines with angioplasty, in which a tiny balloon is threaded into arteries supplying the heart, for preventing deaths, heart attacks and hospitalization.

After five years, the researchers found no significant differences between the two groups in deaths, heart attacks or strokes.

Doctors say the findings in no way challenge the benefit of using emergency angioplasty to stop heart attacks before they damage the heart.

Researcher William Boden of Western New York VA health care Network in Buffalo called the trial "good news" for patients, because the study shows many can avoid or defer angioplasty.

The study exposed a rift among heart doctors. On one side are those who champion treating artery disease with drugs, including aspirin, statins and blood pressure reducers, that affect every blood vessel. On the other are those who use angioplasty to relieve chest pain by clearing one blockage at a time.

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But angioplasty is costly. About 1.2 million angioplasties are done a year. More than half are done to patients with chronic chest pain, such as those in the study.

The initial cost per patient is about $8,000, said William Weintraub of Christiana Hospital in Newark, Del. The cost of each quality year of life gained by angioplasty tops $200,000, four times the average considered reasonable for medical technology, according to his research.

Since each angioplasty costs $5,295 more than drug therapy, eliminating 350,000 could save as much as $10 billion a year, Weintraub says.

A leading angioplasty backer, Greg Stone of Columbia University, downplayed the findings. Angioplasties always have been performed in stable chest pain patients to relieve pain, not prolong life, he said. But Boden counters: Most physicians today believe "angioplasty does alter prognosis."

After an average of five years, 211 deaths and heart attacks occurred in the angioplasty group and 202 in the drug group, researchers told the American College of Cardiology. The findings also appear online in The New England Journal of Medicine.

Researchers also found drugs alone eased pain almost as well as angioplasty. By five years, 74% of those in the angioplasty group said they pain free, compared with 72% of those who took drugs alone.
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ANGIOPLASTY VS. MEDICATION

A landmark trial released in March 2007 of 2,287 patients pitted angioplasty and medication vs. medication alone:

Rate of deaths, heart attacks and strokes
• Angioplasty group: 20%
• Drug group: 19.5%

Hospitalization rate for heart attacks and worsening chest pain
• Angioplasty group: 12.4%
• Drug group: 11.8%

Hospitalization rate for heart attacks alone
• Angioplasty group: 13.2%
• Drug group: 12.3%

Source: The New England Journal of Medicine

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