The widespread use of angioplasty may not be helpful if you've had a heart attack 3 or more days before. Primarily, angioplasty will stop further damage to the heart muscle, if you get it done in time.
The 2,166 patients in the study had all suffered heart attacks 3 to 28 days before, caused by a completely blocked coronary artery. The median time since the heart attack was eight days. They were in stable condition and free of chest pain, and were picked at random to receive either heart medicines only or balloon treatment and stents with heart medicines. Most got plain metal stents, but about 8 percent got drug-coated ones. The researchers tracked their health for an average of three years.
There were no differences between the groups. They had the same rates of heart attack, death and heart failure. If anything, those who had angioplasty seemed to fare a bit worse than those who did not, but the differences were not statistically significant and might have been because of chance, Dr. Hochman said.
An expert not involved in the research, Dr. Steven E. Nissen, chairman of cardiovascular medicine at the Cleveland Clinic and president of the American College of Cardiology, said the study was independent and well conducted.
“Having an artery open ought to be good for you,” Dr. Nissen said. “Why not open it late? Like a lot of things in medicine, however, when you actually test it in an organized way, in a randomized, controlled trial, you find out it doesn’t work.”
He added, “It will change what I do.”
In an editorial accompanying the study in the journal, two other cardiologists say that late angioplasty may still be worthwhile for some patients. The ones who might benefit, they say, are a small minority — perhaps 10 to 15 percent — who cannot take the class of heart medicines known as beta blockers, which have been proved to increase survival after a heart attack.
A spokesman for Boston Scientific, the leading stent maker in the United States, said Dr. Hochman’s study would not have much impact because the findings applied to only a small subgroup of patients. But the company’s stock price dropped sharply yesterday morning when news of Dr. Hochman’s study first hit the news. It recovered by the end of the day, however, as analysts said the findings were likely to have little effect on stent use. By late afternoon, the rally had wiped out all the morning losses. Boston Scientific ended trading at $15.94, up 8 cents.
You did notice that last line. It is about the money, n'cest pas?