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Angioplasty for chest pain is no bargain: study
CHICAGO- People who get surgery to ease chest pain from a blocked heart artery pay $10,000 more for about the same level of relief they can get from taking a combination of pills, U.S. researchers said on Wednesday.
The finding comes from a large study that compared standard drug therapy with angioplasty to open up blockages in the heart.
'It costs about $10,000 more and you are not getting any more value,' said Dr. William Weintraub of Christiana Care Health System in Newark, Delaware, whose research appears in the journal Cardiovascular Quality and Outcomes.
'We don't have to reflexively do angioplasty on every blockage there is in an artery of the heart,' Weintraub said in a telephone interview.
The surgery, known as PCI for percutaneous coronary intervention, involves threading a balloon-tipped catheter through the arteries and opening up the clog. A tiny wire-mesh coil called a stent is often inserted to prop open the artery.
More than 800,000 of these procedures are performed each year and they represent big business for medical device makers including Medtronic Inc, Boston Scientific Corp, Johnson & Johnson and Abbott Laboratories Inc.
But studies increasingly suggest that many patients can opt for a less invasive approach and still get relief from their chest pain, although it may take more time.
Initial results from the same study last year found balloon angioplasty to restore blood flow to clogged heart arteries plus drug therapy was no better than drugs alone at reducing deaths or heart attacks after 4.6 years, although some people who had the surgery did experience a better quality of life.
Weintraub's team reported in the New England Journal of Medicine that any immediate advantages that angioplasty or stent surgery offered over drugs went away after about three years.
Weintraub said the latest study, dubbed COURAGE, looked at whether angioplasty plus drug treatment was worth the added cost as an initial treatment in people with blocked arteries and chest pain but who are otherwise stable.
The study assessed data on 2,287 patients between 1999 and 2004. 'In any of the ways we looked at it, we found that you cannot find value in it as an initial strategy,' he said.
For stable patients with chest pain, that means they can safely delay costly angioplasty surgery, Weintraub said.
'Before COURAGE, doctors felt they had to open up every blockage there was. Now they feel they can pick and choose,' he said. 'COURAGE allows them to function as doctors rather than technicians.'
The Society for Cardiovascular Angiography and Interventions, which represents doctors who perform angioplasty surgeries, said the study does not show the full picture.
The group said in a statement that nurses in the study helped ensure people kept taking their medications, but studies suggest patients often do not take their drugs faithfully.
'Current stenting and angioplasty provide immediate relief from symptoms, improve quality of life and reduce the need for reintervention for patients,' it said in the statement.
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