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Senior Citizen Health & Medicine
Late Treatment of Heart Attack with Angioplasty
Equals High Cost, Low Results
Minimal initial benefits that patients with PCI enjoy
diminish over time
 Nov. 5, 2007 Trying to better the conditions of
heart attack sufferers, whose treatment has been delayed by three days,
with stents and clot-busting medical therapy is not justified, according
to researchers from Duke University Medical Center.
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In a follow-up to last year's widely reported
Occluded Artery Trial (OAT), which reported that catheterization didn't
seem to prevent second heart attacks, if it were used more than 3 days
after the initial heart attack, a group of Duke researchers looked more
closely at 951 patients to see if there were other benefits from the
procedure.
Their findings were presented today at a
late-breaking trials session of the American Heart Associations annual
meeting in Orlando.
Each year, about one million people suffer heart
attacks in the United States, and studies suggest that for many of them,
the best treatment is speedy use of clot-busting drugs or percutaneous
coronary intervention (PCI), a catheter-based procedure that uses stents
and balloons to open up blocked arteries and was formally called
angioplasty.
Ideally, the procedures should begin within 12
hours of the initial attack. But in real life, that doesnt always
happen because patients delay seeking help and arrive at emergency
departments too late for timely care.
Last year, OAT researchers who had followed 2,166
heart attack patients for up to five years told the American Heart
Association annual meeting that PCI applied 3 to 28 days after the
initial attack apparently didnt make any long-term difference in
preventing second heart attacks, death, or development of heart failure.
All participants in OAT had experienced heart
attacks, were considered high-risk, but were stable with one completely
blocked artery. All of the patients received state-of-the-art drug
therapy, but half also got the late PCI.
Focusing on a representative subset of 951 patients
in the OAT trial, Dr. Daniel Mark, a cardiologist and director of
outcomes research at the Duke Clinical Research Institute, led a team
that measured various aspects of quality of life, including physical
functioning, emotional and social well-being, activity level and the
presence and intensity of pain.
They also calculated the medical costs the U.S.
patients incurred during that period. They were looking for was
secondary benefits that might further justify the high cost of PCI.
Mark said that the patients who got PCI plus
standard medical therapy enjoyed slightly better physical functioning
and less pain four months into treatment, but that these benefits did
not last over time.
In addition, the team discovered that it cost
$10,000 more in doctor and hospital costs to treat the PCI patients.
What we have here is one of those cases where less
is more, says Mark.
While it may seem that going an extra step in
opening up clogged arteries late in the game makes sense, we know that
clinically, it doesnt seem to offer the advantages we expected.
In addition, the minimal initial benefits that
patients with PCI enjoyed diminished over time. Coupling that with the
higher cost, we now know that adding PCI to standard medical care in
opening blocked arteries more than a day after a heart attack is not
good value. In an era when the high cost of health care is the subject
of intense debate, this study offers us one way we can offer high
quality care for less money.
Editors Notes:
The study was funded by the National Heart, Lung,
and Blood Institute.
Co-authors include Wenqin Pan, Nancy
Clapp-Channing, Linda Davidson-Ray, from Duke; John Ross, from Toronto
General Hospital; Rebecca Fox, from Vancouver General Hospital; Gerard
Devlin, Waikato Hospital, New Zealand; Edwin Martin, York Health System;
Eric Cohen, Sunnybrook Health Sciences Center, Toronto; Gervasio Lamas,
Mt. Sinai Medical Center; and Judith Hochman, New York University School
of Medicine.
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