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The High Tech Heart: Is Angioplasty Always Needed for Heart Attack?

separator When you’re having a heart attack, surgeons can perform what’s called an angioplasty to clear blocked arteries. During angioplasty, a tiny balloon is inserted and inflated inside the blocked artery, compressing the blockage against the walls of the artery and opening the area to blood flow. Very often, a stent, a small mesh tube, is inserted into the artery to keep it from collapsing. This procedure does not completely clear arteries, but about 90% of angioplasties provide immediate relief from discomfort and further damage to the heart.

In most cases today, doctors routinely perform angioplasty for all heart attacks. Angioplasty does have a small risk of causing a heart attack, but most cardiologists have believed that even a mild heart attack can progress to a severe one without angioplasty.

But a recent study conducted in Holland may be changing that thinking. The study involved 1,200 patients who had chest pain and who had had mild heart attacks. A heart attack was determined to be mild if enzyme levels indicated muscle damage, but an electrocardiogram pattern did not indicate a major attack.

Cardiologists gave half of the study patients angioplasties right away. The other half received clot-dissolving drugs (also called “clot busters”) and cholesterol-lowering drugs—statins—and were observed to see if the chest pain disappeared. If the pain did go away, doctors didn’t perform angioplasty. If the pain didn’t go away, doctors performed angioplasty. About half of the patients assigned to wait and see did end up having angioplasty.

The researchers in the study point out that if an angioplasty isn’t necessary, it’s best to avoid it. The procedure isn’t risk free, after all.

This new approach may become more common in the U.S. as time goes by. So if you have a mild heart attack and don’t receive angioplasty immediately, don’t become alarmed right away. And as always, ask your doctor any questions you have about your treatment.

Academic Medical Center in Amsterdam; The New York Times, Science Times Supplement, 20 September 2005.
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