Doctors Debate Drugs vs. Surgery for Angina

Data re-analysis supports angioplasty, but not everyone agrees

By Steven Reinberg
HealthDay Reporter
Friday, September 14, 2007; 12:00 AM

Copyright © 2007 ScoutNews, LLC. All rights reserved.

FRIDAY, Sept. 14 (HealthDay News) -- Controversy still swirls around how doctors can best treat patients with the chest pain called stable angina, with some physicians favoring the use of drugs while others vote for surgery.

The results of a major trial, called the Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE), seemed to indicate that drug therapy was preferable to angioplasty, since only drug therapy reduced patients' risk of heart attack and death. Those findings were published in March.

But now, researchers taking a fresh look at the data say the opposite may true. They find that angioplasty is usually the best first line of defense against angina.

Will that settle the issue? It's doubtful, experts say.

"There is a lot of debate on both sides of the issue," said Dr. George A. Diamond, a professor of medicine at the University of California, Los Angeles, and co-author of an accompanying journal editorial.

There's a large group of people who believe that these people need to be treated to remove their symptoms completely, and the best way to do that is with interventional procedures such as angioplasty and stenting, Diamond said.

"However, there is another group of individuals who feel the problem can be handled medically," Diamond said.

In the new review of the COURAGE data, Dr. Dean J. Kereiakes, from Christ Hospital Heart and Vascular Center/The Lindner Research Center in Cincinnati, and colleagues come down on the side of angioplasty as first-line treatment for patients with stable angina.

The study authors noted that COURAGE showed significantly better reduction in angina and a reduction for the need for repeat angioplasty or other invasive procedures compared to drug interventions. In addition, patients treated initially with angioplasty had no increased rates of heart attack or death compared with patients treated with drugs alone.

In the second place, the trial confirmed earlier studies that indicated that not doing angioplasty to open all the patient's narrowed coronary arteries was linked to a poorer outcome and the need for more invasive procedures.