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Senior Citizen Health & Medicine
Medicine and Treatment Work as Well as Opening
Artery with Stent to Prevent Heart Attacks
Stents have no impact on reducing major cardiovascular events
Even combining treatments is no more effective
than medicines
 March 27, 2007 When treating a heart attack,
doctors work as quickly as possible to restore blood flow to the heart
by entering the blocked artery, inserting a balloon to open it and then
inserting a stent to keep it open and the blood flowing. This
percutaneous coronary intervention (PCI), formerly known as
Angioplasty has also been used to treat partially blocked arteries to
improve blood flow to the heart. New Research, however, says patient
receive just as much protection from treatment with medicines and
lifestyle training.
PCI procedures are performed more
than 1 million times a year. Since the introduction of PCI more than 30
years ago, there have been enormous advances in the understanding and
medical treatment of coronary artery disease. While PCI is known to
improve survival when done to restore blood flow in a heart attack, no
study has examined the ability of PCI to improve outcomes over and above
modern, optimal medical therapy (OMT) in patients with stable
coronary disease.
OMT includes guideline-driven
intensive treatment with medicines such as aspirin, statins,
anti-platelets, nitrates, ACE inhibitors, beta-blockers and calcium
channel blockers, as well as lifestyle programs such as smoking
cessation, exercise and weight control and nutrition counseling.
Results of research presented today at the American
College of Cardiologys 56th Annual Scientific Session showed that PCI
combined with OMT was no more effective than OMT alone in preventing
heart attacks and other cardiac events among patients with coronary
artery disease.
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More About PCI |
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Scientific Position of the
American Heart Association on " Percutaneous Coronary
Interventions (previously called Angioplasty, Percutaneous
Transluminal Coronary [PTCA], or Balloon Angioplasty)"
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During PCI, a doctor inserts a catheter into an
artery in a patients arm or leg and advances the catheter into the
coronary arteries where a balloon is inflated to clear the blockage.
Usually, a stent (small, lattice-shaped, metal tube) is implanted into
an artery to help keep it open.
The Clinical Outcomes Utilizing Revascularization
and Aggressive DruG Evaluation (COURAGE) trial enrolled 2,287 patients
at 50 hospitals in the United States and Canada, randomizing them to one
of two study arms: PCI and OMT together or OMT alone.
Enrolled patients suffered from chronic chest pain
(angina pectoris) and had at least a 70 percent blockage of one or more
coronary arteries.
Both groups of patients received OMT.
A majority of the patients in the study were men
(85%) and had experienced chest pain for about two years, with an
average of 10 episodes per week (median three episodes per week).
Most exhibited several risk factors for heart
disease: 29 percent were smokers, 67 percent had hypertension, 38
percent had a prior heart attack, 71 percent had high cholesterol, 27
percent had previous PCI and 69 percent had multi-vessel coronary artery
disease. Approximately half of the patients met criteria for metabolic
syndrome.
Patients in the study group underwent PCI to clear
the affected artery or arteries. Dr. William Boden at Buffalo General
Hospital/Kaleida Health in Buffalo, New York and his collaborating
investigators followed patients for two-and-a-half to seven years, with
a primary endpoint of a death or a non-fatal heart attack.
The results
Results of the study showed a similar rate of
death, heart attack or stroke. There were 211 primary events in the PCI
group and 202 events in the medical therapy group. The 4.6-year
cumulative primary rates of death or non-fatal heart attack were 19.0
percent and 18.5 percent in the PCI and medical therapy groups,
respectively.
Hospitalization rates for acute coronary syndrome
were similar for both groups as well, at 12.4 percent and 11.8 percent,
respectively.
There was no statistically significant difference
between the rates of heart attack: 13.2 percent in PCI plus OMT patients
and 12.3 percent among OMT alone.
The one benefit found for the PCI group was less
angina compared with the medical therapy group, suggesting that while,
on average, PCI does not allow patients to live longer or reduce their
chances for a heart attack, it does improve their symptoms and quality
of life.
"Conventional wisdom would indicate that PCI and
OMT together would be superior to OMT alone. Indeed, that was our
initial hypothesis," said Dr. Boden, lead investigator of the study,
which was supported by the Department of Veterans Affairs.
"But results of the COURAGE trial demonstrate that
two treatments are not always better than one. These findings, along
with data from recent studies of more than 5,000 patients combined, show
that PCI has no impact on reducing major cardiovascular events."
Editors Notes:
The study will be simultaneously published in the
New England Journal of Medicine and will appear in the April 12 print
issue. ACC.07 is the premier cardiovascular medical meeting, bringing
together cardiologists and cardiovascular specialists to further
breakthroughs in cardiovascular medicine.
Dr. Boden will present this study "A Randomized
Trial of Percutaneous Coronary Intervention Added to Optimal Medical
Therapy in Patients With Stable Coronary Heart Disease: Results of the
Clinical Outcomes Utilizing Revascularization and Aggressive Drug
Evaluation (COURAGE) Trial" today, March 27 at 9:10 a.m. in Hall A.
The American College of Cardiology (www.acc.org)
represents the majority of board certified cardiovascular physicians in
the United States. Its mission is to advocate for quality cardiovascular
care through education, research, promotion, development and application
of standards and guidelines- and to influence health care policy. ACC.07
and the i2 Summit is the largest cardiovascular meeting, bringing
together cardiologists and cardiovascular specialists to share the
newest discoveries in treatment and prevention, while helping the ACC
achieve its mission to address and improve issues in cardiovascular
medicine.
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