3/29/2007 - Nonsurgical treatments a safe first choice for stable coronary artery disease, study suggests NEW ORLEANS, March 28, 2007—Angioplasty isn't always needed as a first-round treatment for people who have stable coronary artery disease, according to a study presented at the 56th Annual Scientific Session of the American College of Cardiology. The study found that combining angioplasty with a nonsurgical treatment strategy known as optimal medical therapy (OMT) didn't prevent more heart attacks than using OMT alone. While the findings suggest that some of the angioplasties performed each year may be unnecessary, researchers stressed that the study was not intended to show that one type of treatment was always better than the other. And they noted that some people who only received OMT did eventually require angioplasty or bypass surgery. But they said the study offers compelling evidence that OMT can be safely used as an initial treatment in the majority of people with stable coronary artery disease. Still, determining whether angioplasty might be advisable remains a decision for a person and his or her doctor, according to researchers. The study involved 2,287 people who had angina (chronic chest pain) and at least a 70 percent blockage of one or more coronary arteries. Researchers randomly placed people into one of two treatment groups: angioplasty and OMT together or OMT alone. Angioplasty is a procedure in which a tiny tube is inserted into an artery in the arm or leg and threaded to the blocked artery in the heart. Once there, a balloon on the catheter’s tip is inflated to break up the obstruction. OMT includes a combination of medicines (such as aspirin, statins, anti-platelets, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers) and lifestyle programs (such as smoking cessation, exercise and weight control, and nutrition counseling). Researchers followed the participants for an average of 4.6 years. In that time, there were 211 deaths or nonfatal heart attacks in the angioplasty/OMT group and 202 in the OMT alone group. The difference in heart attack rates between the two groups was not statistically significant. The one benefit found in the angioplasty/OMT group compared to the OMT group was less angina. That suggests that, while on average angioplasty does not allow people to live longer or reduce their chances of a heart attack, it does improve their symptoms and quality of life. However, the study revealed that even that benefit became indistinguishable with time. Researchers said the fact that participants were predominantly male and Caucasian was a limitation of their study. The study will appear in the April 12 print issue of the New England Journal of Medicine. Back