Cardiologists emphasize the importance of rapidly reopening blocked coronary arteries with clot-busting drugs or preferably an angioplasty in patients who've just had a heart attack. They also generally believe that opening a blocked coronary artery even later would benefit their patients.

So most cardiologists were shocked recently when a report showed that stable patients who had an angioplasty two days or longer after a heart attack had no fewer subsequent heart attacks than those who had only medical therapy after a heart attack. Medical therapy included the use of beta-blockers and ACE inhibitors, aspirin, cholesterol-lowering drugs, and clopidrogel (Plavix).

In the study, 2,166 patients with one or two totally blocked coronary arteries were divided into two groups: two days or more after a heart attack, the first group received medical therapy alone and the second angioplasty (with a stent) plus medical therapy.

During a four-year follow-up period, no significant differences were seen between those treated medically or with angioplasty in the rates of death, heart attack, or heart failure. However, one year after the heart attack, arteries were open in 83 percent of the angioplasty patients and only 23 percent of those treated with medical therapy alone.

Though the study was funded by the National Institutes of Health, most of the patients came from other countries. Many U.S. centers had declined to participate because they were already certain that angioplasty was superior to medical therapy. That assumption was proven wrong by this study.

The head of the study, Dr. Judith Hochman, said "There is no benefit to opening that artery days to weeks later." The results of this study, she continues, "support the routine use of aggressive secondary prevention [medical therapy] without revascularization [angioplasty to open a blocked artery] as the preferred treatment." Nonetheless, cardiologists still believe in the value of late angioplasty in unstable patients and in those with blockages of the left main coronary artery or three coronary arteries.

In a future entry, I'll write more on efforts by hospitals to ensure faster angioplasties when people come to an emergency room with a heart attack.