MARILYNN MARCHIONE, AP Medical Writer, "Most Angioplasties Unneeded,
Study Finds", Fox News, March 26, 2007,
Link: http://www.foxnews.com/wires/2007Mar26/0,4670,StentsvsDrugs,00.html

More than half a million people a year with chest pain are getting an
unnecessary or premature procedure to unclog their arteries because
drugs are just as effective, suggests a landmark study that challenges
one of the most common practices in heart care.

The stunning results found that angioplasty did not save lives or
prevent heart attacks in non-emergency heart patients.

An even bigger surprise: Angioplasty gave only slight and temporary
relief from chest pain, the main reason it is done.

"By five years, there was really no significant difference" in
symptoms, said Dr. William Boden of Buffalo General Hospital in New
York. "Few would have expected such results."

He led the study and gave results Monday at a meeting of the American
College of Cardiology. They also were published online by the New
England Journal of Medicine and will be in the April 12 issue.

Angioplasty remains the top treatment for people having a heart attack
or hospitalized with worsening symptoms. But most angioplasties are
done on a non-emergency basis, to relieve chest pain caused by clogged
arteries crimping the heart's blood supply.

Those patients now should try drugs first, experts say. If that does
not help, they can consider angioplasty or bypass surgery, which
unlike angioplasty, does save lives, prevent heart attacks and give
lasting chest pain relief.

In the study, only one-third of the people treated with drugs
ultimately needed angioplasty or a bypass.

"You are not putting yourself at risk of death or heart attack if you
defer," and considering the safety worries about heart stents used to
keep arteries open after angioplasty, it may be wise to wait, said Dr.
Steven Nissen, a Cleveland Clinic heart specialist and president of
the College of Cardiology.

Why did angioplasty not help more?

It fixes only one blockage at a time whereas drugs affect all the
arteries, experts said. Also, the clogs treated with angioplasty are
not the really dangerous kind.

"Even though it goes against intuition, the blockages that are severe
that cause chest pain are less likely to be the source of a heart
attack than segments in the artery that are not severely blocked,"
said Dr. David Maron, a Vanderbilt University cardiologist who helped
lead the new study.

About 1.2 million angioplasties are done in the United States each
year. Through a blood vessel in the groin, doctors snake a tube to a
blocked heart artery. A tiny balloon is inflated to flatten the clog
and a mesh scaffold stent is usually placed.

The procedure already has lost some popularity because of emerging
evidence that popular drug-coated stents can raise the risk of blood
clots months later. The new study shifts the argument from which type
of stent to use to whether to do the procedure at all.

It involved 2,287 patients throughout the U.S. and Canada who had
substantial blockages, typically in two arteries, but were medically
stable. They had an average of 10 chest pain episodes a week _
moderately severe.

About 40 percent had a prior heart attack more than three months
previously.

"We deliberately chose to enroll a sicker, more symptomatic group" to
give angioplasty a good chance to prove itself, Boden said.

All were treated with medicines that improve chest pain and heart and
artery health such as aspirin, cholesterol-lowering statins, nitrates,
ACE inhibitors, beta-blockers and calcium channel blockers. All also
were counseled on healthy lifestyles _ diet, exercise and smoking
cessation.

Half of the participants also were assigned to get angioplasty.

After an average of 4 1/2 years, the groups had similar rates of death
and heart attack: 211 in the angioplasty group and 202 in the
medication group _ about 19 percent of each.

Heart-related hospitalization rates were similar, too.

Neither treatment proved better for any subgroups like smokers,
diabetics, or older or sicker people.

At the start of the study, 80 percent had chest pain. Three years into
it, 72 percent of the angioplasty group was free of this symptom as
was 67 percent of the drug group.

That means you would have to give angioplasties to 20 people for every
one whose chest pain was better after three years _ an unacceptably
high ratio, Nissen said.

After five years, 74 percent of the angioplasty group and 72 percent
of the medication group were free of chest pain - "no significant
difference," Boden said.

The study was funded by the U.S. Department of Veterans Affairs, the
Medical Research Council of Canada and a host of drug companies. Stent
makers refused to help pay for the research, said scientists who led
the study.

The study renewed a heated animosity between doctors who perform
angioplasty and other heart specialists.

In fact, one who does the procedures and who spoke at a meeting in New
Orleans sponsored by stent maker Boston Scientific Corp. was
responsible for the early release of the study's results, which were
not due out until Tuesday.

The study "was rigged to fail, and it did," the Wall Street Journal
quoted Dr. Martin B. Leon of Columbia University telling several
hundred of his colleagues Sunday night.

"A lot of people have been taking shots at us, and we need to go on
the offense for awhile," the Journal reported Leon said.

He claimed to have inside knowledge of the results because he reviewed
the study for the New England Journal. The journal would not comment,
saying the identity of its reviewers is confidential.

The cardiology college issued a statement saying it was "extremely
disappointed" results were released prematurely, "betraying the
confidentiality of the scholarly process and the professional
integrity of the scientific community."

The college "will be considering strong sanctions against the
individual or individuals involved," the statement said.

Shares of Boston Scientific were down $1.15, or nearly 8 percent, to
$14.07 in afternoon trading on the New York Stock Exchange. It was a
nearly five-year low for the stock.

Dr. Spencer King of Piedmont Hospital in Atlanta, a leading
cardiologist who does many angioplasties, said he was disappointed in
the study results.

"How many patients have interventions in which the only expectation is
to reduce the use of nitroglycerin or to walk a bit faster? Most
patients anticipate a better prognosis and might opt for an extended
course of medical therapy if they believe they are not putting their
life at excess risk," he wrote in a recent editorial in an American
Heart Association journal.

In an interview at the cardiology meeting, King said he recently had
surgery for back pain and did not expect permanent relief but added,
"If it only held up for five years, I wouldn't be happy about it."

The new study "should lead to changes in the treatment of patients
with stable coronary artery disease, with expected substantial health
care savings," Dr. Judith Hochman of New York University wrote in an
editorial in the journal.

Angioplasty costs $30,000 to $40,000. The drugs used in the study are
almost all available in generic form.

Maron, the Vanderbilt doctor who helped lead the study, said people
should give the drugs a chance.

"Often I think that patients are under the impression that unless they
have that procedure done, they're not getting the best of care and are
at increased risk of having a heart attack and die," he said.

The study shows that is not true, he said.