NIH-Funded Study Disputes Current Practice Regarding Angioplasty and Stents

In a surprising new study that may affect thousands of heart-attack victims, researchers determined that the effectiveness of angioplasty and stenting is greatly diminished if the procedure takes place even a few days after the initial attack. The study, known as the Occluded Artery Trial (OAT), was funded by the National Institute of Health’s National Heart, Lung, and Blood Institute (NHLBI) and is set to appear in the December 7 issue of the New England Journal of Medicine.

According to the NIH, “About one-third of heart attack patients do not receive treatment to open blocked arteries within the recommended 12-hour timeframe after a heart attack…. For years it has been thought that late balloon angioplasty of these patients’ arteries, if they are totally blocked, is still beneficial and might prevent future heart failure, another heart attack, or death. However, according to the results of a large international multi-center clinical trial, stable patients who had angioplasty plus stenting three to 28 days after a heart attack did no better than patients on medical therapy (primarily drug treatment) alone.”

NHLBI Director Dr. Elizabeth G. Nabel says, “These results challenge the long-standing belief that opening a blocked artery is always good. Instead, the study suggests that late angioplasty is unnecessary in this circumstance. The good news is there have been tremendous advances in drug therapy for heart-attack patients. Drug therapy is an important treatment option.”

The OAT studied 2,166 patients in 27 countries, assigning one group to drug therapy only and another to a combination of angioplasty, stenting, and drug therapy. Doctors found “no statistically significant difference in major cardiovascular events between the two groups over an average of three years and up to five years,” according to the NIH.

New York University School of Medicine’s Judith Hochman, who chaired the OAT study, says, “Our findings indicate that routine late opening of the heart-attack-related coronary artery is not appropriate and should be reserved only for certain patients such as those who are unstable or continue to have chest pain following a heart attack. These results should lead to lower rates of unnecessary coronary interventions in this specific group of stable patients.”

“There’s an important public health lesson to be learned from the OAT trial results: seek care very early after heart-attack symptoms begin because that’s when there is a great deal of benefit from angioplasty,” adds Dr. Alice Mascette, chief of NHLBI’s Heart Failure and Arrhythmias Branch and a member of the OAT study steering committee.

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