delay can be fatal

New Delhi, Nov. 16: Challenging current practices of dealing with heart attacks, an international study made public two days ago has shown that delayed angioplasty is no better than drugs in preventing a new heart attack or death.

The five-continent study has shown that patients who have no symptoms, yet opt for angioplasty a few days after the heart attack, do not reduce their risk of having another heart attack, heart failure or death, compared with patients who take only drugs.

Angioplasty is a mechanical procedure to open up blocked arteries and there has been consensus within the cardiac community that opening up 100 per cent blocked arteries within 12 hours after a heart attack to restore blood flow to the heart benefits patients.

However, for years, doctors have also been opening up blocked arteries beyond this 12-hour window, without hard evidence that it indeed helped patients.

The new study, presented at the American Heart Association’s meeting in Chicago, has shown that patients who had angioplasty three to 28 days after the heart attack had, after four years, similar rates of complications as did patients who were given only drugs.

“These results challenge the long-standing belief that opening a blocked artery is always good,” said Elizabeth Nabel, director, National Heart, Lung, and Blood Institute at the US National Institutes of Health. The study, covering 2,166 patients in 27 countries, will be published in the New England Journal of Medicine.

“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 who are unstable or continue to have chest pain after a heart attack,” said Judith Hochman, professor of cardiology at the New York University School of Medicine, who chaired the study.

Cardiac care specialists said the findings would be relevant to India where the number of angioplasty procedures has steadily increased in recent years. “There was this unproven hypothesis that an open artery is always better than a closed artery,” said Om Prakash Yadava, director of the National Heart Institute in New Delhi.

“Many patients in India have been offered delayed angioplasty without any real evidence that it would help them,” Yadava told The Telegraph.

“After a heart attack, it’s crucial to determine through tests whether the heart muscle linked to the artery is already damaged or not,” said Ashok Seth, chairman and chief cardiologist at Max Heart Institute in New Delhi.

“Opening up an artery for dead heart muscle may not have any benefit,” said Seth.

“Such a study would be difficult in India where patients pay for the angioplasty. We would have had to explain to patients that the delayed angioplasty may or may not benefit them. It is an expensive procedure.”

The new study, known as the Occluded Artery Trial, even detected a trend towards more heart attacks in the angioplasty group, although it was not statistically significant.