Healthy Living
Angioplasty - Coronary Artery Disease
By David Perlmutter, MD, FACN
Coronary angioplasty is an invasive medical procedure in which a small catheter is threaded into blocked coronary arteries in an attempt to re-establish blood flow. When the catheter arrives at a region of blockage, a small balloon is inflated, expanding in the arterial channel, and compressing the offending plaque build-up and other debris into the arterial wall.
We are now witnessing a significant increase in the utilization of this procedure in the treatment of acute myocardial infarction. Patients admitted to hospitals with coronary artery blockages are often rapidly transported to the X-ray department for emergency "life saving" coronary angioplasty. But a recent study appearing in The New England Journal of Medicine (October 24, 1996), challenges the wisdom of this approach. In their report, doctors from the University of Washington compared the mortality during hospitalization, long term mortality, as well as the use of monetary resources of patients admitted to hospitals with acute myocardial infarction in 19 Seattle hospitals treated with either coronary angioplasty or the use of a medication given intravenously designed to dissolve blood clots. The data of this large and comprehensive study indicate, "In a community setting, we observed no benefit in terms of either mortality or the use of resources with a strategy of primary angioplasty rather than thrombolytic therapy in a large cohort of patients with acute myocardial infarction." This is to say that patients having the much more aggressive (and profoundly more expensive) angioplasty technique did no better than patients who simply received intravenous medicine designed to break up blood clots (thrombolytic therapy).
We marvel at the new advances in medical technology, and with good reason. Recent advances in medical sciences have taken us to new frontiers which we would not have even dreamed about a decade ago. Nevertheless, it is important to realize that just because a technique is new and "state of the art" it may not be the most appropriate choice. Indeed, as this study now demonstrates, a high tech and very expensive technique may offer no advantages when compared to the time tested standard.