Durgesh nandan jha | Updated: Nov 18, 2019, 4: 20 IST
New Delhi: Patients with a narrowedheartartery, who do not have any symptoms like frequent and worsening pain in the chest, may not require invasive therapy. They can do as well with medicaltherapyalone, a major study called ISCHEMIA Trial involving over 5, 000 heart patients has confirmed. It was released on Sunday in an annual meeting of the American Heart Association (AHA).
In India, nearly 4.5 lakh patients undergo angioplasty annually. Many people also undergo bypass surgery to open up the blocked artery.
Dr Ambuj Roy, professor of cardiology at AIIMS, told TOI nearly one-third of such interventions involve patients with stableIschemicHeart Disease (IHD) who do not have any serious symptoms. “The ISCHEMIA Trial shows such patients may do as well on medical therapy. It is significant, ”he said.
IHD refers to heart problems caused by narrowed heart arteries. This can ultimately lead to heart attack.
In the ISCHEMIA Trial, which started in July 2012, the researchers from top medical institutions across the globe selected 5, 179 patients with stable IHD. These patients weren’t having a heart attack and they did not have blockage in the left main coronary artery. Most of them had narrowed arteries that were detected during exercise stress test.
Total 2, 591 patients continued on medical therapy that included blood thinner, medicines to reduce cholesterol and to slow the heartbeat. The rest 2, 588 patients underwent routine invasive therapy that included angioplasty and bypass surgery .
Usually, one would like to believe that removing the blockage using a stent or through bypass surgery would significantly reduce the risk of complications as compared to having medicine alone. However, during the follow-ups that went on for an average of 3.3 years, the researchers found there were no significant differences in the two groups.
Overall complication at 3.3 years occurred in 13 .3% of patients who underwent routine invasive therapy compared with 15 .5% of patients who remained on medical therapy.
All-cause death among those who underwent invasive therapy was 6.4% compared with 6.5% of the medical therapy group, which is insignificant.
“Angioplasties are over-performed. If a patient has chronic but stable chest pain he or she doesn’t require emergency angioplasty. There are advance drug therapies that can take care of the condition. However, in cases where the patient has acute symptom or the chest pain is getting more frequent, invasive therapy may be required, ”said Dr Ashok Seth, chairman of Fortis Escorts Heart Institute.
Dr Sujoy Shad, cardiac surgeon at Sir Ganga Ram hospital, said that unlike in the US where people tend to visit hospitals for minor symptoms, people in India visit the Answers only when their condition has significantly worsened. “I don’t think there are too many patients who undergo needless procedures,” he added.
In India, 40 to 50 million people suffer from IHD. It accounts for approximately 15% to 20% of all deaths, according to studies. Patients require lifestyle changes such as healthy eating and regular physical activity to reduce the risk, say cardiologists.
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