Late Angioplasty After a Heart Attack

Doctors recommend that people who have heart attacks receive treatment to open their blocked arteries within 12 hours after an attack.  Even past those 12 hours, though, a procedure to open blocked arteries called angioplasty was thought to prevent future heart problems.  A new study, however, found that stable patients getting late angioplasty did no better than patients on drug therapy alone.

Each year, about a million people in the U.S. have a heart attack and half of them die.  The NIH-funded Occluded Artery Trial sought to find out whether it really helped stable patients to perform angioplasty 3-28 days after a heart attack in a totally blocked coronary artery related to the heart attack.

A total of 2,166 patients were randomly assigned to receive drug therapy or routine angioplasty with stenting (placing a metal mesh tube in the artery to keep it open) along with drug therapy.  The trial found no significant difference between the groups over an average of 3 years and up to 5.  There was a trend toward more heart attacks in the angioplasty group but it was not statistically significant.  The patients will need to be followed for longer to see if any significant trends emerge.

“These results challenge the long-standing belief that opening a blocked artery is always good,” said NHLBI director Dr. Elizabeth G. Nabel.  The late opening of a coronary artery involved in a heart attack should be reserved only for certain patients, the researchers say, such as those who are unstable or continue to have chest pain after a heart attack.

If you think you’re having a heart attack, this study shows how important it is to seek care as soon as possible.  But don’t forget that controlling the risk factors for heart disease—such as high cholesterol and high blood pressure—is your first line of defense against heart attacks.