NCPA - National Center for Policy Analysis

Drug Treatment Compared With Angioplasty For Heart Disease

July 11, 2000

Angioplasty -- in which a catheter with an attached balloon is used to open clogged blood vessels -- is increasingly used in non-acute coronary heart disease; however, drug therapy may be better, says a new study in the British Medical Journal. If the findings hold up, drug treatment may also be the more cost-effective alternative -- leaving aside the issue of the cost of the therapies themselves -- because negative treatment outcomes require additional expenditures.

In a systematic review, researchers identified six randomized controlled trials involving more than 1,900 patients that compared angioplasty with drug treatment. Among their findings:

  • In non-acute coronary heart disease angioplasty reduced angina but put patients at a 59 percent higher risk of needing coronary bypass grafting during later stages of the disease.
  • Angioplasty patients were at a 42 percent higher risk for a subsequent heart attack (myocardial infarction) than patients treated with medicines.
  • They also had a 32 percent higher risk of death and a 29 percent higher risk of subsequently needing angioplasty.

The evidence for the effects of angioplasty versus medical treatment is limited, say researchers, because trials have not included enough patients.

Source: Heiner C Bucher, et al., "Percutaneous transluminal coronary angioplasty versus medical treatment for non-acute coronary heart disease: meta-analysis of randomized controlled trials," British Medical Journal, July 8, 2000.

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