Drugs as good as angioplasty for stable heart disease

14 March, 2013

Aggressive drug therapy is just as good as angioplasty for patients with stable heart blockages. There has been a belief amongst cardiologists that all patients with chronic stable heart disease need to have either an angioplasty or heart bypass surgery.

Patients with stable heart disease make up about three–quarters of all the patients who undergo angioplasty and receive stents.

According to "Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE) trial", optimal drug therapy, when combined with lifestyle changes, has equal results as that of angioplasty and optimal medical therapy combined.

The study published issue of the New England Journal of Medicine randomly assigned 2,300 patients with stable but significant heart disease to one of two treatment regimens. The first group received drug therapy alone, while the second group received the drug therapy plus angioplasty.

Follow up showed that 19% in the angioplasty group had died or had a heart attack, compared to 18.5% in the group that only received drug treatment. The only benefit of angioplasty was that it reduced chest pain over the long–term compared with drug therapy alone. About 30% of the patients who received drug therapy alone did eventually undergo angioplasty because their symptoms couldn't be managed with drugs alone.

In addition, about 21% of the patients who received stents needed to have another procedure. Although angioplasty was better at relieving symptoms, it wasn’t better in preventing death or heart attack.

Drug therapy for patients with stable heart disease should be tried as first–line treatment. Angioplasty should be reserved for patients who have continuing symptoms.