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ICES study finds many patients with stable angina improve with medicines alone


Angioplasty (a procedure used to widen a narrowed or obstructed blood vessel in the heart) may not be the only avenue for stable heart disease patients with chest pain. New research out of the Institute for Clinical Evaluative Sciences (ICES) has found that many patients with angina (chest pain) are adequately treated with medicines alone and may not necessarily need to have angioplasty.

Although recent studies have shown that angioplasty does not reduce death or heart attacks in stable heart disease patients, it is traditionally believed that angioplasty reduces symptoms of chest pain more completely than medicines alone.

Principal investigator and ICES scientist Dr. Dennis Ko and colleagues evaluated this conventional wisdom in a comprehensive study that spanned the era of angioplasty from 1992 to 2007. The study included 14 separate clinical trials, enrolling 7,818 patients randomized to either treatment with angioplasty or treatment with medicine alone. They found that:

  • In older trials, the benefit of angioplasty on chest pain relief was almost three times more effective than medicines.
  • In more modern trials – with contemporary medical therapy and modern angioplasty technology – there was no difference in symptom relief between the two groups. Medical therapy has become more effective over time and is associated with greater freedom from angina, which explains its increased benefit and use in modern trials.

"Our study illustrates that many stable heart patients with chest pain respond sufficiently well to medicines and may be able to avoid being subjected to the potential risk of an angioplasty procedure," says Ko.

Author affiliations: ICES (J.V. Tu, D.T. Ko); Division of Cardiology, Schulich Heart Centre and Dept. of Medicine, Sunnybrook Health Sciences Centre, U of T ((H. C. Wijeysundera, J. V. Tu, D.T. Ko); Health Services and Research Development Center of Excellence, Ann Arbor VA Medical Center, Ann Arbor, Michigan (B. K. Nallamothu); Section of Health Policy and Administration, Dept. of Epidemiology and Public Health; Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine; and the Center for Outcomes Research and Evaluation, Yale-New Haven Health, New Haven, Connecticut (H. M. Krumholz) and Dept. of Health Policy, Management and Evaluation, U of T (J. V. Tu, D.T. Ko)

The study "Meta-analysis: effects of percutaneous coronary internvention versus medical therapy on angina relief" is in the March 16, 2010, issue of Annals of Internal Medicine.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.



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