Monday, November 5, 2007

DCRI researchers find no significant long-term positive impact for delayed angioplasty
by Kelly Winget, DCRI Communications

Studies suggest that heart attack patients should ideally receive either drugs to break up clots or stents to widen arteries within 12 hours of the initial attack. Many patients do not seek treatment at the first sign of a heart attack and can miss this ideal treatment window.

DCRI researchers recently found that treating patients with stents after this window passes doesn't produce lasting benefits to justify the high cost of the treatment.

Results published last year from the Occluded Artery Trial (OAT) indicated that catheterization doesn't seem to prevent second heart attacks or reduce the chance of death if it is performed between three and 28 days after an initial heart attack. Catheterization, or percutaneous coronary intervention (PCI), involves inserting a thin tube into a patient's arteries to widen them and improve blood flow.

Daniel Mark, MD, MPH, director of outcomes research at the DCRI, led a research team that studied a subset of 951 of the original OAT patients. The goal was to determine if there were any quality-of-life improvements in patients who had received delayed PCI treatment.

The findings, presented November 5 at the American Heart Association's annual Scientific Sessions, stated that improved physical mobility and decreased pain in patients lasted approximately four months following a delayed PCI. The researchers also found that it typically cost $10,000 more to treat the U.S. patients with PCI rather than with clot-busting drugs alone.

All of the patients in the original OAT study received the latest drug treatments to improve blood flow through their heart. About half of the patients also had a PCI. Mark and the team noted that the patients who had received both therapies fared slightly better than patients who only had the drug therapy, but the small improvements did not last.

“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 doesn't seem to offer the advantages we expected,” said Mark. “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.”

Other DCRI researchers included Wenquin Pan, Nancy Clapp-Channing and Linda Davidson-Ray.