Heart attack patients who undergo angioplasty, an invasive treatment to urgently open clogged heart arteries, are less likely to have another heart attack or to die within the next 5 years than those who receive clot-busting drug treatment, Dutch researchers report.
During angioplasty, a balloon-tipped catheter is inserted into a clogged
heart artery and inflated to restore the normal flow of blood.
Treatment with an intravenous drug called streptokinase can also clear
blocked arteries after a heart attack, but research shows that drug treatment is
not as effective as angioplasty at preventing deaths and repeat heart attacks in
the first month after treatment, according to Dr. Felix Zijlstra and colleagues
at the Hospital De Weezenlanden in Zwolle, the Netherlands.
However, it has not been clear which type of treatment is more effective
in the long run, the researchers note in the November 4th issue of The New
England Journal of Medicine.
To compare the long-term effects of each treatment, Zijlstra's team
followed the progress of 395 heart attack patients. The study participants were
randomly assigned to either undergo angioplasty or to receive intravenous drug
therapy.
After an average of 5 years, angioplasty was the clear winner. While 24%
of people who received drug therapy died during the study, just 13% in the
angioplasty group died. In addition, Zijlstra's team also reports that 22% of
people in the streptokinase group had another nonfatal heart attack, compared
with just 6% of the angioplasty group.
Patients treated with medications were also more likely to be readmitted
to the hospital for heart failure and other heart problems than the angioplasty
group, according to the investigators.
"Although angioplasty is initially more expensive than (drug) therapy,
long-term follow-up shows that angioplasty results in comparatively lower
charges," the authors note.
According to Zijlstra and colleagues, for each person still alive at the
end of the study, total medical costs averaged $18,664 per person in the
angioplasty group and $21,772 in the drug therapy group.
