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PCI After Heart Attack Not Effective Over Long Term

Percutaneous coronary intervention not beneficial over medical therapy after myocardial infarction

THURSDAY, Feb. 19 (HealthDay News) -- Percutaneous coronary intervention (PCI) is expensive and does not benefit quality of life, only producing a modest short-term benefit in cardiac physical function that is not maintained, according to a report published in the Feb. 19 issue of the New England Journal of Medicine.

Daniel B. Mark, M.D., of the Duke University Medical Center in Durham, N.C., and colleagues compared PCI plus stenting with medical therapy alone in 951 patients who had an occluded infarct-related artery between three to 28 days following a myocardial infarction. Patient quality of life was measured using the Duke Activity Status Index (DASI), which assesses cardiac physical function, and the Medical Outcomes Study 36-Item Short-Form Mental Health Inventory 5, which assesses psychological well-being.

After four months, patients who underwent PCI had a slight but significant improvement in cardiac physical function compared with the medical therapy group (mean DASI scores: 36.8 versus 33.3), the researchers report. However, this significant benefit was not maintained at either a one- or two-year follow-up. No significant differences were found in psychological well-being between the two groups. However, patients who underwent PCI had a $7,000 increase in costs after two years, the investigators found.

"PCI was more expensive than medical therapy alone at two years, and the small benefits observed with regard to symptoms were insufficient to make PCI an economically attractive strategy for patients who were eligible for this study," the authors write.

Several pharmaceutical companies supported the study and several of the study authors report financial relationships with the pharmaceutical industry.

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