- The Washington Times - Wednesday, September 14, 2005

BOSTON (AP) — Recovery from small heart attacks went just as well when doctors gave drugs time to work as when they favored quick vessel-cleaning procedures, according to a new study that challenges established practice.

The Dutch finding raises perplexing questions about how to handle the estimated 1.5 million Americans who each year who have small heart attacks — the most common kind. Most previous studies support the aggressive approach.

“I think both strategies are more or less equivalent. I think it is more a matter of patient preference, doctor preference, logistics and, in the long run, it could be a matter of cost,” said the study’s lead researcher, Dr. Robbert J. de Winter , at the University of Amsterdam. The wait-and-see approach is usually cheaper.

Under current American and European guidelines, patients with small heart attacks must be rushed into a hospital laboratory to be tested for coronary-artery blockages. Then, they usually are given bypass operations or angioplasties, which clear the clog with a small balloon. In the Dutch study, drugs were given time to work in half the patients before any decision was made on further treatment.

The latest findings were laid out today in the New England Journal of Medicine. The Dutch team focused on 1,200 heart-attack patients for a year. Though they were undergoing heart attacks, the patients’ heart-wave tests did not indicate major attacks.

One set of patients was given blood-thinning drugs and angiography tests within 48 hours to check on their need for procedures. In the end, almost 80 percent of them got angioplasties or bypasses.

The second group got the drugs, but no aggressive measures until much later and only if symptoms persisted. After a year, just more than half needed the more aggressive treatment.

Few died in either group — only 2.5 percent. In the first group, 23 percent either died, suffered another heart attack or went back to the hospital with chest pain. Only 21 percent did in the conservative group — a statistical tie.

Dr. Eugene Braunwald, a Harvard Medical School cardiologist and chairman of the professional committee devising the U.S. guidelines in 2002, said this study alone — though well executed — should not change current practice.

“I don’t think one study should upset the whole apple cart,” he said.

Others said it’s time to consider at least modest changes in guidelines and practice.


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