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A28 SCIENCE
Monday 18 noveMber 2019
Big study casts doubt on need for many heart procedures

By MARILYNN MARCHIONE Drugs also have improved
AP Chief Medical Writer a lot in recent years. Hav-
PHILADELPHIA (AP) — ing a procedure did prove
People with severe but better at reducing chest
stable heart disease from pain, though. Of those who
clogged arteries may have had pain daily or weekly
less chest pain if they get when they entered the
a procedure to improve study, half in the stent-or-
blood flow rather than just bypass group were free
giving medicines a chance of it within a year versus
to help, but it won't cut their 20% of those on medicines
risk of having a heart attack alone. A placebo effect
or dying over the following may have swayed these
few years, a big federally results — people who know
funded study found. they had a procedure tend
The results challenge medi- to credit it with any im-
cal dogma and call into provement they perceive
question some of the most in symptoms.
common practices in heart Dr. Alice Jacobs, a Boston
care. They are the stron- University cardiologist who
gest evidence yet that tens led a treatment-guidelines
of thousands of costly stent panel a few years ago, said
procedures and bypass any placebo effect fades
operations each year are with time, and people with
unnecessary or premature a lot of chest pain that's un-
for people with stable dis- relieved by medicines still
ease. In this Feb. 16, 2017 file photo, surgeons perform a non-emergency angioplasty at Mount may want a procedure.
That's a different situation Sinai Hospital in New York. In this Feb. 16, 2017 file photo, surgeons perform a non-emergency "It's intuitive that if you take
than a heart attack, when angioplasty at Mount Sinai Hospital in New York. the blockage away you're
a procedure is needed Associated Press going to do better, you're
right away to restore blood diologist with no role in the Twelve years ago, a big a bypass in the rest. going to feel better," but
flow. research. Some doctors study found that angioplas- Doctors then tracked how the decision is up to the pa-
For non-emergency cases, still may quibble with the ty was no better than medi- many in each group suf- tient and doctor, she said.
the study shows "there's no study, but it was very well cines for preventing heart fered a heart attack, heart- The bottom line: There's no
need to rush" into invasive done "and I think the results attacks and deaths in non- related death, cardiac ar- harm in trying medicines
tests and procedures, said are extremely believable," emergency heart patients, rest or hospitalization for first, especially for people
New York University's Dr. Ju- he said. but many doctors balked worsening chest pain or with no or little chest pain,
dith Hochman. About 17 million Americans at the results and quarreled heart failure. doctors said.
There might even be harm: have clogged arteries that with the methods. After one year, 7% in the When told they have a
To doctors' surprise, study crimp the heart's blood So the federal government invasively treated group problem that can be fixed
participants who had a supply, which can cause spent $100 million for the had one of those events with a stent, "the grand
procedure were more likely periodic chest pain. Cheap new study, which is twice versus 5% of those on medi- majority of patients in my
to suffer a heart problem or and generic aspirin, cho- as large, spanned 37 coun- cines alone. At four years, experience will opt to un-
die over the next year than lesterol-lowering drugs and tries and included people the trend reversed — 13% dergo that procedure”
those treated with medi- blood pressure medicines with more severe disease of the procedures group to get improvement right
cines alone. are known to cut the risk — a group most likely to and 15% of the medicines away, said Dr. Jay Giri, a
Hochman co-led the study of a heart attack for these benefit from stents or a by- group had suffered a prob- cardiologist at the Univer-
and gave results Saturday folks, but many doctors also pass. lem. Averaged across the sity of Pennsylvania with no
at an American Heart As- recommend a procedure All 5,179 participants had entire study period, the role in the study.
sociation conference in to improve blood flow. stress tests, usually done on rates were similar regard- Maryann Byrnes-Alvarado
Philadelphia. That's either a bypass a treadmill, that suggested less of treatment. is not among them. The
"This study clearly goes — open-heart surgery blood flow was crimped. If stents and bypasses did 66-year-old New York City
against what has been the to detour around block- All were given lifestyle ad- not carry risks of their own, "I woman said she joined
common wisdom for the ages — or angioplasty, in vice and medicines that think the results would have the study six years ago af-
last 30, 40 years" and may which doctors push a tube improve heart health. Half shown an overall benefit" ter having trouble walk-
lead to less testing and in- through an artery to the also were given CT scans to from them, said another ing, which "scared me to
vasive treatment for such clog, inflate a tiny balloon rule out dangerous block- study leader, Dr. David death," but so did the idea
patients in the future, said and place a stent, or mesh ages, then continued on Maron of Stanford Univer- of a heart procedure.
Dr. Glenn Levine, a Baylor scaffold, to prop the artery their medicines. sity. "But that's not what we She was relieved when she
College of Medicine car- open. The others were treated as found. We found an early was assigned to the medi-
many people with abnor- harm and later benefit, cation treatment group.
mal stress tests are now: and they canceled each Her doctor altered her
They were taken to cardiac other out." blood pressure medicine,
catheterization labs for an- Why might medicines have added a cholesterol drug
giograms. The procedure proved just as effective at and aspirin, and adjusted
involves placing a tube into reducing risks? her diet. Now her risk fac-
a major artery and using Bypasses and stents fix only tor numbers are better and
special dyes to image the a small area. Medicines af- she can walk again without
heart's blood vessels. Block- fect all the arteries, includ- difficulty. "I believe I got the
ages were treated right ing other spots that might best care that I could get"
away, with angioplasty in be starting to clog, experts and avoided an operation,
three-fourths of cases and said. she said.q