Angioplasty Provides No Benefit After 24 Hours

Angioplasties provide no benefit to patients who have experienced heart attacks when performed more than 24 hours after the events, according to a study presented on Tuesday at the annual meeting of the American Heart Association and published online by the New England Journal of Medicine, the Los Angeles Times reports.

Physicians agree that angioplasties and subsequent implantation of stents into arteries can reduce damage to the heart muscle and prevent deaths when performed within 12 hours of heart attacks, but whether the procedure benefits patients after 12 hours remains inconclusive (Gellene, Los Angeles Times, 11/15).

The study, funded by the National Heart, Lung and Blood Institute, involved 2,166 U.S., Canadian, Australian, European and Israeli patients who sought treatment three to 28 days after they experienced mild heart attacks caused by one blocked artery from 2000 through 2004 (Jordan, Newark Star-Ledger, 11/15). Participants, who were in stable condition and did not have chest pain, received either treatment with medication alone or angioplasties and stents in combination with medication (Grady, New York Times, 11/15).

After four years, participants in both groups had similar rates of death, serious heart failure or subsequent heart attacks, the study found. After five years, 21.2% of participants who received angioplasties had experienced subsequent heart attacks, compared with 16.5% of those who received medication alone, according to the study. The difference was not statistically significant, researchers said.

David Hillis of the University of Texas Southwestern, who co-wrote an editorial that accompanied the study, recommended that physicians no longer perform angioplasties on stable patients after 24 hours. He wrote, "There should be a substantial savings in patient discomfort and also monetarily" (Los Angeles Times, 11/15).

The study is significant because as many as one-third of the one million U.S. residents who experience heart attacks annually do not receive care within the first 12 hours of the event. According to researchers, the results of the study indicate that patients who have chest pain should seek treatment as soon as possible to reduce heart damage (Wall Street Journal, 11/15).

In addition, the results of the study "contradict a long-held belief that opening vessels to restore blood flow is always beneficial and could spare thousands of patients from undergoing the costly and potentially risky procedure," the Times reports (Los Angeles Times, 11/15).

However, the results of the study "don't apply to most Americans suffering a heart attack," according to the AP/Detroit Free Press (Marchione, AP/Detroit Free Press, 11/15).

"The bottom line is very clear: There was no benefit to a routine strategy of angioplasty," lead study author Judith Hochman, director of cardiovascular clinical research at the New York University School of Medicine, said (Wall Street Journal, 11/15).

Elizabeth Nabel, director of NHLBI, said that the study is "definitive." She added, "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."

Steven Nissen, chair of cardiovascular medicine at the Cleveland Clinic and president of the American College of Cardiology, said, "It will change what I do," adding, "Having an artery open ought to be good for you. ... Like a lot of thinks in medicine, however, when you actually test it in an organized way, in a randomized, controlled trial, you find out it doesn't work" (New York Times, 11/15).

Ray Gibbons, president of AHA, said, "This is a good example of a negative study that will improve the efficiency of health care in this country," adding, "The U.S. health care system is remarkably inefficient" (Newark Star-Ledger, 11/15).

An abstract of the study is available online.

The editorial also is available online.

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