Following on a trend noted in previous posts here and here, this NY Times article (see also here) reports that findings from a major new study suggest that noninvasive treatment with beta-blockers and other heart drugs turns out to be at least as good as angioplasty for patients whose arteries remain blocked at least three days after a heart attack. The findings — which were presented earlier this week at the annual scientific meeting of the American Heart Association and published simultaneously online by the New England Journal of Medicine — supplement an increasing body of research that is indicating that heart-attack patients whose disease is stable and whose symptoms are under control should be wary of taking the risk of invasive treatment, which can result in infection and bleeding.
Over the past 20 years or so, treatment of heart attacks has been transformed by the ability of doctors to break up blood clots that cause the heart attacks with clot-busting drugs and angioplasty procedures. By quickly restoring blood flow to the heart muscle following an attack, doctors have been able to save lives and minimize damage that can lead to total heart failure. However, a nagging problem has been that about a third of the million or so Amerians who suffer a heart attack each year do not arrive at a hospital within the 12-hour window after the attack during which the patients are most likely to benefit from these techniques. In those patients who stabilize on their own after an attack and then are not diagnosed with blocked arteries until days after the attack, the conventional wisdom has been to go ahead and perform the angioplasty, anyway.

The trial, which was funded by the National Heart, Lung and Blood Institute, involved about 2,200 men and women who had a totally blocked artery three to 28 days after suffering a heart attack. They were assigned randomly to receive either just the best-available drug therapy or drug therapy plus angioplasty and stent treatment. Blocked arteries were opened successfully in about 90% of the angioplasty patients and they opened spontaneously in about 25% of the patients taking just medication.
After four years, 17.2% of patients in the angioplasty group had died, suffered another heart attack or developed serious heart failure. In comparison, 15.6% in the group on medication alone had the same results. Although the relatively small difference could have resulted from mere chance, researchers suggest that the findings do not support the the higher risk of aggressive intervention in such patients.
The bottom line: People with chest pains should get to the hospital as soon as possible because quick application of clot-busting drugs and angioplasty remains the best way to preserve the heart muscle. But if the patient fails to do so and stabilizes on their own, then the benefit of an angioplasty later may not be worth the risk.