Delayed Angioplasty Has No Long Term Benefits

Delayed angioplasty may not be worth the risk and cost once the optimal treatment window has closed according to new research from Duke University Medical Center. The benefits of catheterization have been under debate after research suggested that the procedure did not prevent second heart attacks if catheterization was used more than three days after the first hear attack. In this study, Duke University researchers wanted to determine if there were other possible benefits of delayed catheterization.

When a person has a heart attack, the use of drugs to break up clots or catheterization should occur within the first twelve hours. Typically, percutaneous coronary intervention is to open a blocked artery. In the procedure, a balloon is slowly inflated to widen the blocked artery.

However, many patients are not treated during that initial treatment window because they delay seeing a doctor. Once a patient arrives at an emergency department, the time when the anti clotting drugs and catheterization are most effective may have already closed.

Research has found that if these measures are taken 3 to 28 days after a heart attack, they offer no long term advantage. The heart attack patients still had the same chances of dying, having a second heart attack, or having heart failure as those that received no preventative after care.

All participants in the Duke University Medical Center study had already experienced heart attacks and had one blocked artery. While all patients received drugs to protect their hearts from future damage, half of the participants also got a delayed percutaneous coronary intervention.

In addition to measuring possible medical benefits, the researchers followed up with the patients to find out if they experienced any enhanced quality of life, activity level, or physical functioning. They also looked for any symptoms of pain after the percutaneous coronary intervention.

The researchers concluded that those who received the delayed percutaneous coronary intervention had less pain and better physical control four months after surgery. However, the advantage did not continue in the long-term, and cost an additional $10,000 in most cases.

"What we have here is one of those cases where less is more," said Daniel Mark, cardiologist and author of the study in a press release. "While it may seem that going an extra step in opening up clogged arteries late in the game makes sense, we know that clinically, it doesn't seem to offer the advantages we expected. In addition, the minimal initial benefits that patients with PCI enjoyed diminished over time. Coupling that with the higher cost, we now know that adding PCI to standard medical care in opening blocked arteries more than a day after a heart attack is not good value. In an era when the high cost of health care is the subject of intense debate, this study offers us one way we can offer high quality care for less money."

Source:

Duke University Medical Center, "Delayed angioplasty -- big bucks, no bang" Eurekalert