NEW YORK, March 18 (Reuters) -- People who suffer certain types of heart attack may be more likely to survive the attack if they get less -- not more -- aggressive treatment, a surprising new study suggests.
The report looked at those with a non-Q-wave myocardial infarction, a type of heart attack that makes up about half of the 1.5 million heart attacks that occur every year in the U.S.
The standard treatment for this type of attack is cardiac catheterization, a diagnostic procedure in which a catheter is threaded through a vein into the heart, followed by bypass surgery or artery-clearing angioplasty.
Overall, 1.3% of people with non-Q-wave heart attacks who were treated with drugs and "watchful waiting" died in the two weeks after the attack compared with about 4% to 5% of those given more aggressive treatment, such as angioplasty or bypass surgery, according to the report scheduled to be presented this week at the American College of Cardiology meeting in Anaheim, California.
"I think we have operated under an unproven assumption that patients would have a more favorable course if treated invasively and aggressively, that is to say heart catheterization as routine strategy followed by balloon angioplasty or bypass surgery," said study author Dr. William Boden, director of the medical service at the VA Upstate Health Care System in Syracuse, New York. "I think physicians in general, and cardiologists in particular, have been convinced that the outcomes would be significantly better in this group, where it turns out to be just the opposite. I think this is going to be information that will surprise, if not shock, some of the cardiologists."
The study, called the VA non-Q-wave Infarction Strategies in-Hospital, or VANQWISH trial, included 462 patients treated with invasive catheterization or surgery, and 458 with noninvasive medication and procedures, such as heart scans or exercise tests. Some in the 'conservative' treatment group went on to have bypass surgery or angioplasty if noninvasive tests suggested it was necessary.
"I believe the issue here is not whether non-Q-wave patients would not ultimately benefit from revascularization (bypass surgery or angioplasty)," stated Boden. "It's that you shouldn't be performing routine early invasive intervention on them because you may, in fact, worsen the short-term outcome."
In the aggressively treated group, there were 70 second heart attacks, and 80 deaths during the three-year study, and in the conservatively treated group there were 79 heart attacks and 59 deaths.
"The non-Q-wave heart attack is a heart attack that is not complete. It hasn't killed the whole thickness of the heart wall, it's killed part of it," said Dr. Adolph Hutter, a clinical cardiologist at Massachusetts General Hospital in Boston. "As opposed to a Q-wave infarction that is a much more extensive heart attack, but very frequently a completed event."
"This study actually says that the routine angioplasty or surgery actually causes harm -- it's a very important point to make," explained Hutter, a past president of the American College of Cardiology. "I think it will significantly affect the way patients with non-Q-wave myocardial infarctions will be managed in the future."
"There's two important points -- it will save money, but more importantly -- will save lives," he concluded.
