Prescription Drug Therapy Often as Effective as Costly Angioplasty in Treating Non-Emergency Patients With Chronic Chest Pain, Study Finds

Treatment with medication over time is as effective as an angioplasty, which can cost $40,000, in the alleviation of chest pain in patients with stable heart disease, according to a study published Thursday in the New England Journal of Medicine, the AP/San Francisco Chronicle reports.

For the study -- funded by the Department of Veterans Affairs, the Medical Research Council of Canada and several pharmaceutical companies -- William Weintraub of Christiana Care Health System and colleagues examined 2,287 patients with stable heart disease who received a combination of medications that possibly included aspirin, statins, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers (Marchione, AP/San Francisco Chronicle, 8/14). Half of the participants also underwent angioplasties and had bare-metal stents implanted (Fauber, Milwaukee Journal Sentinel, 8/14).

Researchers conducted a survey of about 70% of participants and found that 78% had chest pain when the study began. According to the survey, 53% of participants who underwent angioplasties reported no chest pain after three months of treatment, compared with 42% of those who only took medication. The conditions of participants in both groups continued to improve after six months of treatment, and the gap decreased, the survey found. After three years of treatment, participants in both groups reported similar levels of chest pain, quality of life and treatment satisfaction, according to the survey.

Weintraub said patients' conditions improve whether they undergo angioplasties or only take medication.

Editorial
In an editorial that accompanied the study, Eric Peterson of the Duke University Clinical Research Institute and John Rumsfeld of the Denver VA Medical Center and the University of Colorado-Denver Health Sciences Center wrote, "This study should be enlightening and practice-changing for doctors and patients alike" and should increase the use of treatment with medication for patients with stable heart disease (AP/San Francisco Chronicle, 8/14). They added, "A strategy of upfront angioplasty is not warranted" (Milwaukee Journal Sentinel, 8/13).

In addition, Peterson said in an interview, "There are a lot of forces, in terms of payment, the influence of manufacturers and all the shiny new devices that are coming on to the market, that are encouraging use" (Nussbaum, Bloomberg/Minneapolis Star Tribune, 8/13).

The study is available online. The editorial also is available online.