Navigation Links
Docs Debate Drugs vs. Surgery for Angina

Data re-analysis supports angioplasty, but not everyone agrees

FRIDAY, Sept. 14 (HealthDay News) -- Controversy still swirls around how doctors can best treat patients with the chest pain called stable angina, with some physicians favoring the use of drugs while others vote for surgery.

The results of a major trial, called the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE), seemed to indicate that drug therapy was preferable to angioplasty, since only drug therapy reduced patients' risk of heart attack and death. Those findings were published in March.

But now, researchers taking a fresh look at the data, say the opposite may true. They find that angioplasty is usually the best first line of defense against angina.

Will that settle the issue? It's doubtful, experts say.

"There is a lot of debate on both sides of the issue," said Dr. George A. Diamond, a professor of medicine at the University of California, Los Angeles, and co-author of an accompanying journal editorial.

There's a large group of people who believe that these people need to be treated to remove their symptoms completely, and the best way to do that is with interventional procedures such as angioplasty and stenting, Diamond said.

"However, there is another group of individuals who feel the problem can be handled medically," Diamond said.

In the new review of the COURAGE data, Dr. Dean J. Kereiakes, from Christ Hospital Heart and Vascular Center/The Lindner Research Center in Cincinnati, Ohio, and colleagues come down on the side of angioplasty as first-line treatment for patients with stable angina.

The authors noted that COURAGE showed significantly better reduction in angina and a reduction for the need for repeat angioplasty or other invasive procedures compared to drug interventions. In addition, patients treated initially with angioplasty had no increased rates of heart attack or death compared with patients treated with drugs alone.

In the second place, the trial confirmed earlier studies that indicated that not doing angioplasty to open all the patient's narrowed coronary arteries was linked to a poorer outcome and the need for more invasive procedures.

Third, despite intensive medical therapy for stable coronary disease patients -- which Kereiakes sees as unrealistic -- "severe or progressive symptoms led to a surprisingly high rate (32 percent) of 'crossover' to revascularization [surgery] in patients initially assigned to medical therapy alone," they noted in their paper in the Oct. 16 issue of the Journal of the American College of Cardiology released Friday.

Fourth, Kereiakes' team believes that the clinical benefits of drug therapy plus angioplasty give patients, particularly those with disease in more than one vessel, the biggest benefit in terms of reducing chest pain.

Still, a case-by-case approach may be best, the team said.

"The choice of therapy (s) for each individual patient must be made based on coronary anatomic suitability and in the context of the patient's lifestyle, functional capacity, level of symptom limitation, and their ability (physically, emotionally, and financially) to take the prescribed treatment," Kereiakes' group notes. "If PCI (angioplasty) revascularization is performed, this procedure should be done using the most complete and effective tools and always in addition to (rather than in place of) medical therapies that reduce [cholesterol] plaque progression," they concluded.

Despite these findings, Diamond said that the COURAGE trial showed that drug therapy was as effective as drug therapy plus angioplasty for patients with stable angina. "Angioplasty provided no additional benefit over optimal medical care," he said. "That gores the ox of those who believe strongly in angioplasty."

Diamond's own stance? He believes angioplasty is the correct initial treatment for patients who have suffered a heart attack but not for patients with chronic stable angina.

"Patients with mild angina should be tried on medical therapy alone," he said. "The evidence has shown that there is a reasonable level of expectancy that that will relieve the symptoms. In addition, it has proven benefit in lowering the risk of heart attack and death, which has not been shown for angioplasty."

Which treatment any patient may get is dependent on the doctor he or she sees, Diamond added. "Truth be told, aside from the emotional belief that opening the vessel gives a better-looking X-ray, the studies don't bear that out," he said. "If you go to a physician who believes in these procedures and does them himself, you are much more likely to get a procedure rather than medical therapy."

Financial incentives also encourage that, Diamond said.

"We get paid a lot more for doing procedures than we do for giving sage advice and simply writing a few prescriptions," he said.

Despite the data, Diamond expected the debate to continue so long as treatment guidelines are ambiguous and don't reflect the latest evidence for the best medical care. "We need to realign the current practice guidelines to be consistent with the evidence," he said.

More information

For more about angina, visit the American Heart Association.

SOURCES: George A. Diamond, M.D., professor, medicine, University of California, Los Angeles; Oct. 16, 2007, Journal of the American College of Cardiology

Copyright©2007 ScoutNews,LLC.
All rights reserved

Related medicine news :

1. Debate Rages over firing of HIV infected health care workers
2. Stem cell research- now Nobel Laureates join the debate
3. FDA debates status of decongestant drugs
4. Good carb, bad carb? Experts debate.
5. Debate On Marriage
6. New Mexico Debates Over Forcing Mentally Ill People To Seek Treatment
7. Bird flu raises debate in EU for compensation for farmers
8. Salt & Its Intake Causes a Strong debate In UK
9. Debate in US: Who Should Decide for Disabled People?
10. Skinny Debate Upsets Actress Knightley
11. Scientists Saying Against Trees Sparks Debate
Post Your Comments:
(Date:6/24/2016)... ... June 24, 2016 , ... ... Scientific Sessions in Dallas that it will receive two significant new grants to ... came as PHA marked its 25th anniversary by recognizing patients, medical professionals and ...
(Date:6/24/2016)... , ... June 24, 2016 , ... ... offering micro-osteoperforation for accelerated orthodontic treatment. Dr. Cheng has extensive experience with all ... brackets , AcceleDent, and accelerated osteogenic orthodontics. , Micro-osteoperforation is a revolutionary ...
(Date:6/24/2016)... , ... June 24, 2016 , ... Topical BioMedics, Inc, makers of Topricin and MyPainAway ... call for a minimum wage raise to $12 an hour by 2020 and then adjusting ... restore the lost value of the minimum wage, assure the wage floor does not erode ...
(Date:6/24/2016)... ... June 24, 2016 , ... EB Medicine presented its ... Emergency Medicine conference in Ponte Vedra Beach, FL. The awards honor the outstanding ... Medicine Practice and Pediatric Emergency Medicine Practice. , “With this award, we ...
(Date:6/24/2016)... ... June 24, 2016 , ... Puradigm® & Innovative Solutions ... initiated cultivation and processing operations at its production facility, and opened its first ... is the manufacturer of a complete system of proactive air and surface purification ...
Breaking Medicine News(10 mins):
(Date:6/24/2016)... , June 24, 2016 The Academy of ... recommendations that would allow biopharmaceutical companies to ... entities that make formulary and coverage decisions, a move ... of new medicines. The recommendations address restrictions ... appear on the drug label, a prohibition that hinders ...
(Date:6/24/2016)... -- According to a new market research ... Safety Pen Needles), Needle Length (4mm, 5mm, 6mm, 8mm, ... Purchase (Retail, Non-Retail) - Trends & Global Forecasts to ... for the forecast period of 2016 to 2021. This ... 2021 from USD 1.65 Billion in 2016, growing at ...
(Date:6/23/2016)... 23, 2016  MedSource announced today that it ... software solution of choice.  This latest decision demonstrates ... to their clients by offering a state-of-the-art electronic ... establishes nowEDC as the EDC platform of choice ... clients.  "nowEDC has long been a preferred EDC ...
Breaking Medicine Technology: