BOSTON (Reuters) - Using drugs alone may take longer than angioplasty or stent surgery to help restore blood flow in patients with clogged arteries but in the long run patients do just about as well, researchers reported on Wednesday.
The surgery, known as PCI for percutaneous coronary intervention, may provide more short-term relief for some patients with severe or more frequent chest pain but the benefits tend to fade over the years, the international team of researchers reported in the New England Journal of Medicine.
They assessed 2,287 volunteers in 50 U.S. and Canadian medical centers as part of a study called COURAGE, for Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation.
They reported last year that patients getting drugs alone for chest pain known as angina and for heart disease are no more likely to die or have a heart attack during the follow-up period of 30 to 84 months than people who also received PCI.
“COURAGE demonstrates that both treatment strategies can have a profoundly positive effect on patients’ health status and suggests complementary roles -- optimal medical therapy as first-line therapy, with PCI reserved for patients who do not have a response or who have severe baseline symptoms,” Dr. Eric Peterson of Duke University Medical Center in Durham, North Carolina, and John Rumsfeld of the Denver Veterans Affairs Medical Center, wrote in a commentary.
“You can say to patients, ‘you won’t be at increased risk if we don’t put a stent in that blockage right now,’” Dr. William Weintraub of Christiana Care Health System in Newark, Delaware, who led the study, said in a telephone interview.
He and his colleagues found that PCI recipients experienced more immediate relief from chest pain and felt fewer physical limitations. But after one year, that began to change. By the three-year mark, there was no significant difference between the two groups.
They calculated that if all patients received the best drug therapy, adding PCI would produce significantly better chest pain relief in only one out of 17 patients. And for every 25 who received the PCI surgery, only two would have a significantly improved quality of life.
Ultimately, 21 percent of the patients who initially received drugs alone ended up getting PCI treatment.
Weintraub and several of the other researchers reported getting consulting fees and grants from many different drug companies.
In their commentary, Peterson and Rumsfeld noted that PCI carries extra risks.
For every 1,000 patients treated with PCI first, they said, approximately two would die, 28 would have a heart attack associated with the surgery, 60 to 90 would do better, and at least 800 would see no difference compared to drug treatment.
The costs of the two therapies have not been compared, yet.
“It is difficult to assert that a PCI-first strategy should clearly be adopted routinely in patients with stable angina,” they wrote.
Editing by Maggie Fox and Vicki Allen
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