Drugs May Hinder, Not Help, Angioplasty

Common practice may actually raise risks to patients, researchers say

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TUESDAY, Feb. 14, 2006 (HealthDay News) -- Treating heart patients with drugs before giving them artery-opening angioplasty or stents is a common strategy that's believed to improve outcomes. But a new review of the data suggests it offers no real benefit and may actually cause harm.

U.S. researchers analyzed data from 17 studies that assessed outcomes for 2,237 sudden ST-elevation heart attack patients.

ST refers to a portion of the graph produced by an electrocardiogram. This category of heart attack usually requires more immediate medical attention.

The team compared outcomes for patients who received drug treatment prior to angioplasty/stent placement against those of 2,267 patients who received angioplasty/stent placement without prior drug treatment.

Reporting Tuesday in the online edition of The Lancet, the researchers found that 106 of the patients who received drugs prior to angioplasty/stent placement died, compared with 78 of the patients in the no-drug group.

In addition, the review's authors concluded that pre-intervention drugs increased risks for non-fatal heart attack, bleeding, stroke, and the need for repeat vascularization treatment.

"Drug facilitated angioplasty or stent placement offers no benefit over primary intervention in ST-elevation heart attack and should not be used outside the context of randomized controlled trials," researcher Dr. Ellen Keeley, University of Texas Southwestern Medical Center, Dallas, said in a prepared statement. "Furthermore, facilitated interventions with thrombolytic based [clot-busting] regimens should be avoided," she said.

The findings are "unequivocal and surprising: [drug-] facilitated angioplasty compared with primary angioplasty alone, rather than saving lives as expected, results in an increase in mortality, along with greater rates of reinfarction, urgent repeat vascularization, major bleeding, hemorrhagic stroke, and total stroke," noted an accompanying comment by Dr. Gregg Stone of Columbia University Medical Center, New York City, and Dr. Bernard Gersh of the Mayo Clinic in Rochester, Minn.

More information

The Society for Vascular Surgery has more about angioplasty and stenting.

SOURCE: The Lancet, news release, Feb. 14, 2006


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