A large head-to-head comparison of angioplasty and clot-dissolving drugs for heart attack victims has ended in a draw.
The study, performed on more than 3,000 patients, found no difference in the death rate after treatment with the rival approaches at ordinary community hospitals.
The issue of which is better has been a hot topic among the nation’s heart specialists, and the latest report is unlikely to settle the debate.
During the past decade, clot-busting drugs such as TPA emerged as the front-line treatment for heart attacks, used on about 180,000 Americans at a cost of $350 million annually. If given soon enough, they can break up blockages in the heart’s arteries, preventing death or permanent damage.
But more recently, an approach called primary angioplasty has challenged the dominance of these drugs. Angioplasty is already a mainstay of treatment for clogged heart arteries. Doctors push a catheter into the artery and inflate a tiny balloon that squeezes open the blockage.
In its new application, some doctors are performing angioplasty as an emergency procedure within an hour or two after the heart attack patient arrives at the emergency room.
Small studies at hospitals that specialize in this approach found that heart attack patients who undergo angioplasty have a 40 percent lower death rate than those who receive clot busters. However, many experts wondered if it would work so well at hospitals where doctors do the procedure less often.
The latest study, led by Dr. Nathan R. Every and colleagues from the University of Washington, was conducted at 19 Seattle-area hospitals, mostly smaller, community hospitals. It was published in Thursday’s issue of the New England Journal of Medicine.