Another Blow for Angioplasty

A major heart study adds to the growing evidence that expensive angioplasties are no better than drugs alone in saving lives

By John Carey

Editors note: For a CBS Evening News report on angioplasty made in collaboration with BusinessWeek, click here, or go to CBS Evening News and search for angioplasty.

There's a powerful logic to the argument that people will live longer and have fewer heart attacks if their clogged arteries are repaired with a procedure called angioplasty. Most commonly, the arteries are widened with a tiny balloon threaded through their blood vessels, then kept open with slender mesh tubes called stents. The logic has turned this medical procedure into a huge—and profitable—business. Each year in the U.S., more than 1.2 million angioplasties are performed, at a cost of more than $25 billion. The cardiologists who open arteries love the sense that they are warding off death, and patients "think the angioplasty saved their lives," says Floyd J. Fowler Jr., president of the Foundation for Informed Medical Decision Making.

But the data show that doctors and patients are wrong. Several recent studies have found that angioplasty doesn't save lives or prevent heart attacks in patients with stable heart disease compared to treatment with drugs. And now, in a study presented at the American Diabetes Assn. meeting on June 7 (and published in the June 11 issue of The New England Journal of Medicine), the limitations of angioplasty are evident even when the procedures were performed on diabetics with heart disease. For those patients, "medical therapy [the use of drugs] rather than any intervention is an excellent first-line strategy," conclude Dr. William E. Boden of the State University of New York at Buffalo and Oxford University's Dr. David P. Taggart in an NEJM editorial.

The new study, which is certain to be pulled into the national debate about how to reduce health-care costs, offers important new insights about which cardiovascular therapies are most effective. In contrast with some previous clinical trials, a large number of the patients undergoing angioplasty received high-tech drug-eluting stents of the sort sold by Johnson & Johnson (JNJ), Medtronic (MDT), and others, which doctors had hoped would offer better outcomes than the older, plain-metal variety. And the study focused on diabetics, many of whom also have heart disease. "We began the study because we don't know how best to treat this deadly duo that is affecting more and more people," explains Sheryl F. Kelsey, a professor of epidemiology at the University of Pittsburgh Graduate School of Public Health and principal investigator of the study. "We were thinking that maybe for this group, revascularization [angioplasty] would be better than medical therapy."

It wasn't. There were no differences in deaths or events like heart attacks between the 798 diabetics who got drugs only and the 807 patients who had their arteries opened in addition to getting the same drugs.

Very Profitable for Docs and Hospitals

This growing evidence that angioplasty brings few benefits has yet to make a dent in the number of procedures performed. "There are people in the cardiology community who don't believe the results. They don't believe it applies to the patients they see," says Dr. Judith S. Hochman, director of the Cardiovascular Clinical Research Center at New York University School of Medicine. "So we still see a lot of angioplasty being done without patients really understanding that it will not reduce their chances of heart attack or death."

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