Docs Debate Drugs vs. Surgery for Angina(rates of heart attack or death compared ...),Health

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
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