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Late stenting not better days after heart attack

BOSTON – The concept of better late than never does not apply when it comes to reopening blocked heart arteries, researchers reported .

A new international study found that when doctors try to use stents to prop open a closed artery days after an untreated heart attack, patients do no better long-term than patients who simply received drugs and other nonsurgical treatment.

In at least one out of three heart attacks, surgeons fail to reopen the blocked artery responsible right away, in part because many heart attack victims do not seek treatment for many hours or days, when heart muscle may already be damaged.

"Our study specifically addresses the question of whether, with a complete blockage, there is any benefit, now that the dust has settled after the acute heart attack, to opening the artery anyhow," said Dr. Daniel Mark of the Duke University Medical Center in North Carolina, who led the study.

"I think our comprehensive answer to that is the benefit is very small and it's not worth the extra cost of doing the procedure."

Earlier results from the Occluded Artery Trial or OAT showed that, four years after the heart attacks, the rate of death, heart failure or a subsequent heart attack was not reduced by a late attempt at removing the blockage.

The new quality-of-life data, reported in Thursday's New England Journal of Medicine, show more reasons why opening an artery too long after a heart attack may be a waste of time and effort.

Although stenting offered some improvement over nonsurgical therapy at the four-month mark, a year later patients were just as unable to walk up stairs, for example, as those who did not get stents.

After two years, the bill for the 477 patients who received the stents was $7,000 higher and their survival rate, adjusted for quality of life, was shorter than for the 474 volunteers who simply got drug treatment.

The findings show that "the heart muscle where that artery is blocked is pretty much dead, and it's not going to help it out by opening the artery," Mark said in a telephone interview.

"The patients studied in OAT did not experience the full benefit of angioplasty and stenting because they received treatment after the heart was irreversibly damaged and no longer able to significantly benefit from the oxygenated blood flow that angioplasty provides," the Society for Cardiovascular Angiography and Interventions said in a statement.

"This is a dangerous situation that can lead to heart failure."