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Study suggests drug therapy may be as effective as angioplasties

PHILADELPHIA -Studies have long shown that angioplasty can save a patient who is having a heart attack. But a study released online in March in the New England Journal of Medicine showed that patients who are not likely to have an immediate heart...

PHILADELPHIA -Studies have long shown that angioplasty can save a patient who is having a heart attack.

But a study released online in March in the New England Journal of Medicine showed that patients who are not likely to have an immediate heart attack fared just as well with drug therapy.

The study found that more than half the patients who get angioplasties - more than a million each year - have heart disease that is stable and would do just as well under medication. The authors said the proportion of unnecessary angioplasties is as high as 85 percent - at a cost of about $30,000 to $40,000 per patient.

David L. Fischman, an interventional cardiologist and codirector of the cardiac-catheterization lab at Thomas Jefferson University Hospital in Philadelphia, said patients and doctors should view angioplasty as a quality-of-life decision. The study found that half the 2,287 patients who received a stent had fewer symptoms, such as angina, at the onset. Those numbers narrowed as the study went on.

Howard C. Herrmann, who directs the Interventional Cardiology & Cardiac Catheterization Laboratories at the Hospital of the University of Pennsylvania, said drug therapy required patients to more rigorously change their habits.

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"How effective are we at optimal medical therapy?" Herrmann asked. "Only about one-third of patients are able to lower cholesterol levels to the point required." He said this study could underscore that patients needed to control all their risk factors.

The study could help put patients at ease when it comes to delaying treatment, Herrmann said.

"The take-home message is you have to know why you're doing a procedure. If it's to improve angina and increase a patient's ability to stay active, a stent is a reasonable therapy to offer." If patients are stable, low risk, and prefer medical therapy, then there is nothing wrong with that approach.

It could also help doctors feel more comfortable about prescribing drugs over angioplasty.

"I think a lot of us believed it was OK to try medication at first," Fields said, "but in the real world when you saw blockage that was bad, it was hard to say just leave it alone." Now that there's evidence, he said, it will be easier.

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