Older
Heart Patients Benefit From Aggressive Treatment
Angioplasty And
Stenting Prevent Deaths
Quick use of artery-opening
procedures such as angioplasty and stenting in emergency situations
could halve the number of deaths or second heart attacks in
older people, according to a report in the Annals of
Internal Medicine.
The new study found
no significant differences in results for younger patients,
those ages 65 and under, who had conservative treatment (watchful
waiting and drug therapy) compared to those who got more aggressive
therapy - angioplasty, stent, or surgery.
But it was a very
different story for patients ages 75 and older, says study author
Dr. Richard G. Bach, an associate professor of medicine at the
Washington University School of Medicine in St. Louis.
"For death or recurrent
myocardial infarction, there was over a 50 percent reduction,"
Dr. Bach says.
The study included
more than 2,200 patients treated in 169 hospitals in nine countries.
Only 10.8 percent of the patients over 75 who had aggressive
treatment died or had a second heart attack, compared to 21.6
percent of those who received conservative treatment, Dr. Bach
notes.
"A 10 percent absolute
percentage reduction is very remarkable," he says. "For every
1,000 patients, 100 events were prevented."
Care
Taken To Treat Older Patients Cautiously
Traditionally, physicians
have hesitated to use aggressive treatment with older heart
patients because they feared it would lead to major bleeding
that could cause serious damage.
In the new study,
the incidence of major bleeding was higher among patients who
got aggressive treatment - 16.6 percent, compared to 6.5 percent
for those who got watchful waiting. But, the problems caused
by that bleeding were outweighed by the benefits of the aggressive
artery-opening strategy.
The findings have
important implications for the older people who make up a large
proportion of the more than 1.4 million patients who get emergency
treatment for heart attacks and other severe cardiac problems
each year in the US, Dr. Bach says.
This study included
a larger number of older people than previous ones, he adds.
Discovery
Lends New Support for Intervention
The findings may
heighten awareness among clinicians about the advantages of
aggressive treatment, Dr. Bach says, and "they are
something that may be reflected in future guidelines."
The results cannot
be applied to all older patients who require emergency heart
treatment, Dr. Bach notes. The study excluded patients who had
other major illnesses, such as cancer.
The finding "adds
a significant amount of credibility to the idea that older people
can be treated aggressively with an interventional approach,"
says Dr. H. Vernon Anderson, a professor of medicine at the
University of Texas Health Science Center in Houston, who also
was involved with the study.
There has been "hesitation
in much of the medical community toward a more aggressive approach
to older people" because of the risk of excess bleeding and
other complications, Dr. Anderson says.
"The data from this
study indicate that even with those problems, older people do
better with an aggressive approach," he says.
Always consult your
physician for more information.
Online
Resources
(Our Organization
is not responsible for the content of Internet sites.)
American
Heart Association
Centers
for Disease Control and Prevention (CDC)
HealthierUS.Gov
National
Heart, Lung, and Blood Institute (NHLBI)
National
Institutes of Health (NIH)
National
Library of Medicine
US
Health and Human Services |
September
2004
Older
Heart Patients Benefit From Aggressive Treatment
Care
Taken To Treat Older Patients Cautiously
Discovery
Lends New Support for Intervention
Angioplasty
Basics
Stent
Basics
Online
Resources
Angioplasty
Basics
Percutaneous transluminal
coronary angioplasty (PTCA) is performed to open blocked coronary
arteries caused by coronary artery disease (CAD) and to restore
arterial blood flow to the heart tissue without open-heart surgery.
A special catheter
(long hollow tube) is inserted into the coronary artery to be
treated. This catheter has a tiny balloon at its tip. The balloon
is inflated once the catheter has been placed into the narrowed
area of the coronary artery.
The inflation of the
balloon compresses the fatty tissue in the artery and makes
a larger opening inside the artery for improved blood flow.
The use of fluoroscopy
(a special type of x-ray, similar to an x-ray “movie”)
assists the physician in the location of blockages in the coronary
arteries as the contrast dye moves through the arteries. A small
sample of heart tissue (called a biopsy) may be obtained during
the procedure to be examined later under the microscope for
abnormalities.
The physician may
determine that another type of procedure is necessary.
This may include the
use of atherectomy (removal of plaque) at the site of the narrowing
of the artery. In atherectomy, there may be tiny blades on a
balloon or a rotating tip at the end of the catheter. When the
catheter reaches the narrowed spot in the artery, the plaque
is broken up or cut away to open the artery.
Atherectomy is used
when the plaque is calcified, hardened, or if the vessel is
completely closed. Another type of atherectomy procedure uses
a laser, which opens the artery by "vaporizing" the plaque.
Stent
Basics
In the past few years,
many refinements have been developed in the PTCA procedure.
One common procedure used in PTCA is stent placement.
A stent is a tiny,
expandable metal coil that is inserted into the newly-opened
area of the artery to help keep the artery from narrowing or
closing again.
Once the stent has
been placed, tissue will begin to form over it within a few
days after the procedure. The stent will be completely covered
by tissue within a month or so.
It is necessary to
take a medication, such as aspirin or clopidogrel (Plavix™),
which decreases the “stickiness” of platelets (a
type of blood cells that clump together to form clots to stop
bleeding), in order to prevent blood clots from forming inside
the stent.
Newer stents (drug-eluting
stents, or DES) are coated with medication to prevent the formation
of scar tissue inside the stent. These drug-eluting stents release
medication within the blood vessel itself.
This medication inhibits
the overgrowth of tissue that can occur within the stent. The
effect of this medication is to deter the narrowing of the newly
stented blood vessel.
Always consult your
physician for more information. |
