Do We Really Need Heart Surgeries For Arterial Blockages?

Grant Boone
November 19, 2019

Levine, a member of the guidelines committee of the American Heart Association, said they will consider the findings for updates to heart treatment guidelines.

Dr Kaul was the leading investigator from India for the seven-year, 5,179-patient ISCHEMIA study, with about 800 patients with blocked arteries recruited under him for the study.

A major global trial has found that high-risk patients with unstable heart disease can be treated well with medications along rather than invasive procedures such as stents and bypass surgeries.

In some cases, patients who underwent invasive techniques were more likely to suffer a heart attack or even die.

While the study confirms that in a section of heart patients there may not be the immediate need to perform an angioplasty or a heart bypass surgery to prop open the blocked artery, experts in the field said only the doctor must take a call on whether a patient falls in the safe category or not. "It is significant", he said.

Many patients with severe but stable heart disease who routinely undergo invasive procedures to clear and prop open clogged arteries would do as well by just taking medications and making lifestyle changes, United States researchers reported on Saturday.

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Patients having a heart attack were not included in the study, nor were other groups, including those with poor heart muscle function or those with narrowing of the heart's main coronary artery. Patients were randomized to receive either an invasive approach consisting of routine cardiac catheterization followed by revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG; n=2,588), or a conservative approach in which patients underwent cardiac catheterization only if OMT failed (n=2,591).

"There's always been a fear that if you don't do something quickly, they will have a heart attack or drop dead", Hochman said.

Cardiologists cautioned that the results applied only to patients with chronic stable angina, marked by brief episodes of pain and squeezing or tightness in the chest after physical exertion or stress. Researchers divided them into groups, receiving either medical therapy alone or a combination of medical therapy and stents or bypass surgery. Dr Sujoy Shad, cardiac surgeon at Sir Ganga Ram hospital, said that unlike in the USA where people tend to visit hospitals for minor symptoms, people in India visit the specialists only when their condition has significantly worsened.

Cardiologists estimate that a significant proportion of patients with chronic stable angina are now prescribed coronary stents or bypass operations.

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