Of the 1,575 patients in a randomized controlled clinical study published in the New England Journal of Medicine in August, 2003, those treated with image-guided angioplasty experienced fewer heart attacks, strokes, or death compared to those who were treated with drug therapy. Source: “A Comparison of Coronary Angioplasty with Fibrinolytic Therapy in Acute Myocardial Infarction,” Andersen et al, NEJM, August 21, 2003.
Medical imaging has helped bring about one of the most dramatic health improvement trends of the past century – the decline in deaths from heart disease and stroke. Age-adjusted death rates per 100,000 persons for heart disease have decreased from 307 in 1950 to 135 in 1996, an overall decline of 56 percent, according to the Centers for Disease Control and Prevention.
A significant amount of this improvement is the result of percutaneous transluminal coronary angioplasty, or PTCA. Introduced in the early 1980s as a less-invasive alternative to coronary artery bypass surgery, this technique has become the "therapy of choice," according to the New England Journal of Medicine, in opening coronary arteries clogged with plaque and re-establishing blood flow to the heart.
PTCA is made possible by imaging technologies, such as X-ray angiography and ultrasound, that show the patient's arteries on a large TV monitor as a physician guides a catheter to the blockage. Sometimes, the physician opens a balloon-type device on the catheter to push the plaque into the artery wall; other times, the physician uses the catheter to place a thin metal tube, known as a stent, inside the artery to keep the artery open.
A wide range of clinical studies have demonstrated the improvement in clinical outcomes from angioplasty – such as reduced mortality and reduced pain from angina. One of the most recent studies compared angioplasty with drug therapy.1Click here to view the study
The 2003 study, published in the New England Journal of Medicine, found that angioplasty reduced the chances of death, disabling stroke, or heart attack by a relative rate of 40 percent for patients at local community hospitals and 45 percent for those at invasive-treatment centers.2
Most of the improvement was in the reduced rate of second heart attacks following the procedure. "The superiority of angioplasty over [drug therapy] was driven by a 75 percent reduction in the relative risk of clinical reinfarction [heart attack]…" said the study.3 An editorial in the same issue noted that "…primary percutaneous coronary intervention is now increasingly recognized as the reperfusion therapy of choice."4Click here to view the study
Also in 2003, the British medical journal The Lancet reported that the combined results of 23 clinical trials, involving the random assignment of 7739 patients, found that patient outcomes for image-guided angioplasty were better than with drug therapy. The study concluded, "The results seen with primary PTCA remained better than those seen with thrombolytic therapy during long-term follow-up, and were independent of both the type of thrombolytic agent used, and whether or not the patient was transferred for primary PTCA."5Click here to view the study
Source: "Primary Angioplasty vs Intravenous Thrombolytic Therapy for Acute Myocardial Infarction: A Quantitative Review of 23 Randomised Trials," Keeley et al, The Lancet, January 4, 2003.
