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Study shows drugs as effective as angioplasty for chest pain


BOSTON According to a new study, patients with chronic chest pain and considering angioplasty, but not in danger of a heart attack, should hold off.

The study, published in the New England Journal of Medicine, indicates that drugs are equally effective.

The early advantage for angioplasty at relieving pain in these non-emergency cases starts to fade within six months and vanishes after three years – much sooner than the five years doctors estimated last year after their first analysis of the study.

“This study should be enlightening and practice-changing for doctors and patients alike,” and should lead more to try drugs before resorting to the $40,000 heart procedure, said Duke University's Dr. Eric Peterson, who co-wrote an editorial in the medical journal.

At least a third of angioplasties are done to relieve chest pain for people not in imminent danger. These patients are no more likely to die or have a heart attack if initially treated with drugs alone, the 2,287-patient study revealed.

Researchers did follow-up health surveys of about 70 percent of the study's participants. At the start, 78 percent had chest pain.

Three months after treatment, 53 percent of patients who had angioplasties plus drug treatment and 42 percent of the patients who used drugs only were free of chest pain. Both groups continued to improve, and the gap started to narrow within six months. After three years, their scores on chest pain, quality-of-life and treatment satisfaction did not significantly differ.

One exception was among patients who started out with more severe chest pain and fared better with angioplasty. And not everyone did well on drugs alone — about one-third ultimately needed an angioplasty or heart bypass surgery.

The study patients also received an ideal mix of medicines, potentially including aspirin, cholesterol-lowering statins, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers.

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