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Study may set new angioplasty guidelines

Stents and balloons not advisable for patients with recent heart attacks.


18 November,2006: In a study that could well change the direction of medical practice, researcher found that opening a clogged blood vessels in the heart may do more harm than good in patients who suffered an attack in the immediate past.

Generally called angioplasty, it is a common practice among cardiologists to open blocked arteries in the heart with balloons and stents. Stents are devices implanted to prop open an artery.

Researchers at New York University medical school noted that stenting can be lifesaving in the early hours after a heart attack. When patients receive treatment late, it is often because they did not realize that they had had a heart attack and delayed going to the doctor or hospital.

They also urged doctors stop trying to open arteries in people who had heart attacks days or weeks before and who are stable and free of chest. 

The study which included 2,166 patients at 217 hospitals in the United States and other countries was presented the results y at a meeting of the American Heart Association in Chicago. The study was also published online by The New England Journal of Medicine.

Dr. Elizabeth G. Nabel, director of the National Heart, Lung, and Blood Institute, which helped pay for the research, said: “This is an important study. It’s definitive. The evidence from it should be weighed very carefully by the groups that formulate guidelines about when to conduct angioplasty in the setting of a heart attack.” 

Experts say the report could mean another warning from researchers who suspect that stents are being overused and may even be causing heart attacks and deaths. Manufacturers sell $6 billion in stents a year, and cardiologists charge $10,000 to $15,000 each to implant them. 

The devices, which came into widespread use in the 1990s, are made of either bare metal or metal coated with a drug meant to help keep the artery from closing again. Recent studies have found that drug-coated stents can increase the risk of blood clots, even years after they are implanted. 

Use of the drug-coated stents has fallen since last spring, but they still account for more than 80 percent of stents implanted in the United States. 

A million Americans a year have heart attacks, and half of them die, according to the National Heart, Lung, and Blood Institute. A common symptom is severe pain in the chest, left arm, jaw or back, but about a third of patients do not have chest pain. Symptoms may also include feeling faint, sweaty, short of breath or nauseated and having a sensation that the heart is pounding. 




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