By Marilynn Marchione.
People with severe but stable heart disease from clogged arteries may have less chest pain if they take the procedure to improve blood flow rather than simply giving drugs a chance to help, but they do not reduce the risk of heart attacks or dying. A large federally funded study was found over the next few years.
The results challenge medical dogma and question some of the most common practices in heart care. These are the strongest evidence, but each year tens of thousands of expensive stent procedures and bypass surgery indicate that they are unnecessary or premature for people with stable disease.
This is different from a heart attack when an immediate procedure is required to restore blood flow.
Dr. from New York University. Judith Hochman shows that in non-urgent cases, studies are "no rush" for invasive tests and procedures.
There may even be harm: To the surprise of physicians, study participants who have a procedure are likely to have a heart problem or die more than being treated with drugs alone over the next year.
Hochman directed the work and gave results at an American Heart Association conference in Philadelphia on Saturday.
Baylor Medical School Cardiology Specialist "This study clearly opposes what common wisdom has been for the past 30, 40 years," Glenn Levine said, and in the future may lead to less testing and invasive treatment for such patients. role in research. Some doctors may still participate in the study, but it was done very well, "and I think the results are extremely convincing."
Approximately 17 million Americans blocked blood vessels, which could cause periodic chest pain. Cheap and generic aspirin, cholesterol-lowering drugs and blood pressure medications are known to reduce the risk of heart attacks for these people, but many doctors have suggested a procedure to improve blood flow.
This is either an bypass – to avoid open heart surgery blockages – or angioplasty for physicians to block the artery, inflate a small balloon, and place a stent to open the artery or sieve scaffold.
Twelve years ago, a large study found that angioplasty was not better than heart attack and death prevention drugs in non-emergency heart patients, but that many doctors ultimately whale and discuss methods.
That's why the federal government has spent $ 100 million for the new study, which is twice as large, involving people in 37 countries and more severely ill – a group likely to benefit from stents or bypass.
All 5,179 participants had stress tests, usually on the treadmill, suggesting that the blood flow was curled. All were given lifestyle recommendations and medications that improved heart health. Half of them also underwent CT scans to rule out dangerous blockages, followed by continued medication.
Others were treated as many people with abnormal stress tests: they were now taken to cardiac catheterization laboratories for angiograms. The procedure involves inserting a tube into the main artery and using special stains to visualize the blood vessels of the heart. Blockages were treated immediately, angioplasty was performed in three quarters and a bypass was performed in the others.
The doctors then monitored how many in each group had a heart attack, heart-related death, cardiac arrest, or hospitalization due to chest pain or heart failure.
One year later, 7% in the invasively treated group had one of these events versus only 5% of these drugs. In four years, the trend reversed – 13% of the procedure group and 15% of the drug group experienced a problem. The rates were similar throughout the study period, regardless of treatment.
If the stents and bypasses did not carry their own risks, he said, düşünüy I think the results will benefit in general, çalışma Dr. Stanford University, another study leader, said. David Maron. “But that's not what we found. We benefited from an early loss and later, and they canceled each other. ”
Why are drugs effective in reducing risks?
Bypasses and stents only secure a small area. Experts said drugs affect all arteries, including other points that may cause blockage.
Drugs have also improved greatly in recent years.
Nevertheless, having a procedure proved to be better in reducing chest pain. Among those who suffered daily or weekly pain when they entered the study, half of the stent or bypass group were freed within one year for 20% of those taking the drug alone. A placebo effect may shake these results – people who know they have a procedure tend to lend with any improvement in their perceived symptoms.
A Boston University cardiologist who led a panel of treatment guidelines a few years ago. Alice Jacobs said that any placebo effect diminishes over time, and people who suffer from too much chest pain that are not trusted by drugs may still want a procedure.
U It is intuitive that you will do better, you will feel better if you remove the obstruction ancak, but the decision depends on the decision of the patient and the doctor.
As a result: Do not hurt to try the drugs first, especially for people who have little or no chest pain, doctors said.
When they say they have a problem that can be solved with a stent, büyük the vast majority of patients in my experience will want to go through this procedure için, Dr. Cardigan, a cardiologist at the University of Pennsylvania. Jay Giri has no role in the study.
Maryann Byrnes-Alvarado is not between them. The 66-year-old New York City woman said that six years ago, when she started working, she had a problem an afraid to scare me katıl, but she also had the idea of heart surgery.
He was relieved when he was assigned to the drug treatment group. Her doctor changed her blood pressure, added a cholesterol drug and aspirin, and adjusted her diet. Now the number of risk factors is better and can walk again without difficulty.
Orum I believe that I have the best care I can do ”and that he has avoided surgery.
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