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Angioplasty No Better Than Drug Treatment in Long Run
Date:8/13/2008

Benefit disappears within three years, study finds

WEDNESDAY, Aug. 13 (HealthDay News) -- There are some advantages to artery-opening angioplasty over drug treatment for people with heart disease, but those advantages disappear within three years, according to the latest report on a pivotal study on the subject.

Angioplasty does offer a higher quality of life for months to a couple of years, said study leader Dr. William S. Weintraub, chief of cardiology at the Christiana Health Care System in Delaware.

In the COURAGE trial, the researchers tested angioplasty, with stent implants, against drug treatment for 2,287 people with stable coronary disease. Earlier analysis found improved quality of life for those having the artery-opening procedure that is formally called percutaneous coronary intervention (PCI). The latest report, in the Aug. 14 issue of the New England Journal of Medicine, found that by 36 months, there was no significant difference in health status between the two treatment groups.

"What one can say is that for people with chronic, stable coronary disease, PCI can be deferred," Weintraub said. "They can continue on medication aimed at their specific risk factors -- hypertension, lipid disorders, diabetes -- and should be encouraged to have a good lifestyle, with exercise, smoking cessation and weight control."

A decision to have PCI can depend on how an individual feels, Weintraub said. "If people say, 'My pain is so bad I can't function,' that is one thing," he said. "If people say, 'I have angina, but I'm doing OK,' that's another."

Angina is the chest pain that is a chief symptom of coronary disease.

Cost could be a factor in some decisions, Weintraub said. PCI is more expensive than drug therapy, but the current report does not mention money. An economic analysis of the COURAGE alternatives was expected to be published in September, Weintraub said.

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