Angioplasty best for "silent" heart attacks

NEW YORK (Reuters Health) - Following a heart attack, many patients continue to have low blood flow to the heart tissue, yet have no symptoms. Findings from a new study suggest that these “silent” heart attacks are best treated with angioplasty rather than with medications.

With angioplasty, a tiny catheter is inserted in an artery in the leg and then, under X-ray guidance, the tip is extended into the coronary arteries feeding the heart. A tiny balloon is then inflated, which opens the blocked artery, ideally restoring blood flow to the heart tissue. Nowadays, angioplasty is often accompanied by the placement of a stent to keep the narrowed artery open.

“This is the first, to our knowledge, long-term outcome study of (angioplasty compared with) drug therapy” in patients with symptomless reductions in coronary blood flow following a heart attack, lead author Dr. Paul Erne, from Kantonsspital Luzern in Switzerland, and colleagues note in the Journal of the American Medical Association.

The findings come from the Swiss Interventional Study on Silent Ischemia Type II (SWISSI II), a trial comparing angioplasty to drug therapy in 201 patients.

During an average follow-up period of 10.2 years, the drug therapy group experienced a total of 67 major heart-related events, such as death due to heart attack and the need for repeat angioplasty or heart surgery. By contrast, just 27 events were seen in the angioplasty group, which translates into a 64-percent reduced risk of these events.

Moreover, heart function in the angioplasty group improved slightly during the study period, whereas it worsened markedly in the drug therapy group.

“We found a persistent benefit of (angioplasty) compared with optimized drug therapy,” the investigators conclude.

SOURCE: Journal of the American Medical Association, May 9, 2007.