NCPA - National Center for Policy Analysis


September 19, 2005

For patients having a mild heart attack, medication and monitoring may work as well as the standard, more invasive approach now used by hospitals, according to a new study in the New England Journal of Medicine.

The research adds fuel to an already heated debate over how to treat the more than one million patients admitted in to U.S. hospitals each year complaining of chest pain, and whose electrocardiogram shows they are likely suffering a form of mild heart attack.

  • The standard approach is invasive and involves threading catheters through the patient's arteries to get an image of vessels near the heart.
  • If narrowed vessels are found, doctors usually place a stent -- a metal mesh tube -- in the artery to keep it open.
  • Doctors may turn to bypass surgery for very serious blockage.

The researchers, expecting to find the invasive therapy to be better, were surprised to find the conservative approach -- using medication and monitoring -- appeared at least as effective as the invasive approach. Consider, a year after the initial hospital visit:

  • An equal percentage of patients, 2.5 percent, had died in each group; subsequent heart attacks occurred in 15 percent of patients undergoing the catheterization, versus 10 percent of those on the conservative strategy.
  • Visits to the hospital for symptoms were slightly more frequent - 10.9 percent versus 7.4 percent -- among patients assigned to the conservative approach.
  • About 54 percent of patients in the conservative treatment group had received stents or undergone bypass surgery, compared with 79 percent of patients in the invasive group.

Cardiologist William E. Boden (University of Connecticut) believes the likely explanation of the new results was better drugs and thinks this should serve as a wake-up call to physicians. The main point, he says, is not to discourage doctors from intervening with an invasive procedure, but to make them realize they are not putting patients in harm's way by deferring intervention for a few days.

Source: Sylvia Pagan Westphal, "Heart-Attack Patients Do as Well With Drugs as With Invasive Steps," Wall Street Journal, September 15, 2005; and Robbert J. de Winter, et al., "Early Invasive versus Selectively Invasive Management for Acute Coronary Syndromes," New England Journal of Medicine, Vol. 353, No. 11, pp. 1095-1104, September 15, 2005.

For WSJ text (subscription required):,,SB112672464040740706,00-search.html

For study text:


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