Drugs as Good as Surgery for Heart

A recent study by Dutch scientists contradicts earlier findings that had found quick angioplasty more beneficial for acute coronary syndrome patients than long-term treatment strategy, with angioplasty done later if needed.

The study conducted by Dr. Robert J. de Winter, from the Academic Medical Center in Amsterdam, shows that aggressive treatment of the condition brings no particular advantage. The report has been published in the September15 issue of the "New England Journal of Medicine".

1,200 patients with acute coronary syndrome (term referring to symptoms associated with ischemia) were under study, divided into two groups: one, who received early invasive treatment strategy, and the other, who were assigned the long-term strategy.

Both treatment strategies showed equivalent clinical outcomes after one year from randomization. Researchers had set as primary endpoints death, non-fatal myocardial infarction or rehospitalization for anginal symptoms.

The incidence of the endpoints was very similar in the two groups - 22.7% in the aggressive therapy group and 21.2% in the other group. As for the mortality rate, it was found to be the same in the two groups - 2.5%. The incidence of myocardial infarction alone was greater in the early intervention group (15% versus 10% in the other group), but rehospitalization was less frequent in the following year - 7.4%, as compared to 10.9% in the long-term medication strategy group.

Researchers admit, however, that results cannot be compared to results of previous studies, due to differences in study design and the risk profile of patients, as well as the definition of endpoints.

Dr. de Winter offers some explanations for the differences in results between this study and the previous ones, among which he mentions a higher rate of reopened arteries in the current trial as compared to earlier ones, as well as optimized medical therapy, which included cholesterol-lowering medication.

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