Medical therapy best for older heart attacks

Heart attacks that are a few days to several weeks old are better treated with medications than with angioplasty. In the long-term, angioplasty does not improve outcomes and is much more costly. Prior research has shown that heart attacks that are only a few hours old are best treated with angioplasty. But whether this also holds true for older attacks in stable patients is unclear.Researchers from America assessed quality of life, heart function, and costs in 951 patients who were randomly assigned to undergo angioplasty with stenting or to receive medical therapy alone 3 to 28 days after they had had a heart attack. All of the subjects were in stable condition at the time of treatment. It was found that angioplasty with placement of a small tube or stent to keep the blocked coronary artery open slightly improved heart function at 4 months, but this benefit later disappeared. Moreover, at 2 years, patients who underwent stenting had a marginally shorter survival, accounting for quality of life, when compared with medical therapy. Therefore, stenting was associated with a slight improvement in heart function at 4 months. By 1 and 2 years, however, no difference in this outcome was seen between the study groups. Both treatments also had a similar impact on psychological well-being.The above finding is just one more reason to question the use of routine (angioplasty and stenting) in late-treatment patients when cheaper, less invasive options are just as effective.