Is surgery always necessary for people with chronic angina? | Health and fitness

MONDAY, Nov. 7, 2022 (HealthDay News) — People suffering from chest pain due to blocked arteries appear to have some flexibility in choosing the medical care that’s right for them, researchers report.

That’s because their overall risk of death was about the same whether they chose aggressive surgical treatment or a more conservative approach focused on drugs and lifestyle changes, according to the results of a seven-year clinical trial.

These findings mirror four years of results from the same study, which focused on people who had angina but no other serious heart-related complications, said lead researcher Dr. Judith Hochman, director of the Grossman School’s Cardiovascular Clinical Research Center. of NYU Medicine in New York.

“We can say with a little more confidence that at seven years there is no difference in survival between the two groups,” she said. “These patients, who are the majority of patients with chronic coronary disease, should discuss with their doctor what the best strategy is for them.”

Angina affects about 4 percent of Americans, or 11 million people, the American Heart Association (AHA) estimates.

The ISCHEMIA trial enrolled people with moderately to severely blocked arteries who still had healthy heart muscle, stable angina and no other recent heart-related disease. These results should not apply to patients with more complex heart disease, Hochmann said.

Nearly 5,200 eligible patients in the study were randomly assigned to one of two groups.

Patients assigned to aggressive treatment typically have undergone angioplasty or open-heart surgery based on their condition, Hochmann said. Patients in the conservative treatment group were prescribed heart medications and asked to adopt healthy lifestyle changes.

After seven years of follow-up, patients in the conservative treatment group had a higher rate of heart-related death, 8.6 percent, compared with 6.4 percent in the aggressive treatment group.

But the aggressive treatment group had a higher rate of noncardiac death, 5.5 percent, compared with 4.4 percent.

“We really can’t explain why non-cardiovascular deaths increased in the invasive strategy,” Hochmann said. “But the two simply cancel each other out, and death from any cause is the same for the invasive versus the conservative strategy over time. After seven years, the levels are the same.”

Based on that, patients with simple angina should feel empowered to choose the treatment path that’s right for them, Hochman said.

“If a patient with mild angina controlled by drug therapy wants these narrowings [of arteries] “fixed”, which some patients do, it is very reasonable to move forward with this as well, because they will not be harmed. They are not going to shorten their lives based on this strategy,” Hochmann said.

“The same goes for the conservative strategy,” she added. “There are many patients who simply do not want invasive procedures. They don’t want stents. They don’t want open heart surgery. It’s very reasonable to say, “Well, we know that in seven years, if you take your medication and change your lifestyle, you’re going to live as long as the patients originally assigned to this invasive strategy.

They would not choose one strategy over another based on survival.

“They would choose it based on their quality of life and their management preferences,” Hochmann said.

The clinical trial is scheduled to continue for another three years and will eventually provide a 10-year picture of the differences between the two groups.

Some doctors are waiting for that full, decade-long analysis to see if a difference in survival eventually emerges, said Dr. B. Hadley Wilson, vice president of the American College of Cardiology.

Wilson noted that heart-related deaths appeared to steadily increase among those receiving conservative versus invasive treatment in the study.

“That really drives home the reason we want to extend it, so we see if those curves continue to separate. In other words, is there a difference between conservative management and invasive management, maybe not at five years, but at 10 years?” ” said Wilson, executive vice chairman of the Sanger Heart & Vascular Institute at Atrium Health in Charlotte, North Carolina

The results of the clinical trials appear in the journal Circulationand were also presented Sunday at the American Heart Association’s annual meeting in Chicago.

More info

The Cleveland Clinic has more on angina.

SOURCES: Judith Hochman, MD, director, Cardiovascular Clinical Research Center, New York Grossman School of Medicine, New York; B. Hadley Wilson, MD, executive vice chairman, Sanger Heart & Vascular Institute at Atrium Health, Charlotte, North Carolina; CirculationNovember 6, 2022

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