Angioplasty for Chronic Stable Angina?

Angioplasty is a common procedure done to help widen narrowed arteries—and it also can help with the pain of chronic stable angina. But many people assume that the procedure lowers the risk of death or heart attacks. Let's review recent research to get the details.

Angioplasty in Emergency Situations

Numerous studies have shown that angioplasty reduces the incidence of death and heart attacks for patients who are hospitalized for acute coronary syndrome (heart attack or unstable angina).

Angioplasty for Chronic Stable Angina

'In contrast, for those patients with chronic stable angina many clinical trials have shown that angioplasty does not lower the risk of death or heart attacks when compared with optimal medical treatment. Such treatment includes controlling blood pressure and lowering LDL cholesterol with lifestyle measures and medications. Moreover, optimal medical treatment of angina has been shown to relieve moderate angina pain just as well as angioplasty.

However, angioplasty relieves the pain of angina more rapidly than medical treatment. So, the procedure should be considered when quality of life and daily activities are significantly impaired by angina that is too severe or frequent.

Angioplasty is Often Deemed Inappropriate

A study in 2011, which reviewed more than half a million angioplasties in more than 1,000 hospitals, concluded that virtually all of those done in the setting of acute coronary syndrome were appropriate. In contrast, only half of those carried out in patients with non-acute coronary heart disease were classified as appropriate – 38 percent were considered uncertain and 12 percent were deemed inappropriate. Most of these inappropriate procedures were performed in patients with no angina (54 percent) or low-risk ischemia; and 96 percent were not receiving optimal medical treatment for chest pain.

Risks of Angioplasty

It's vital to know that risks that come with this procedure. In about 85 percent of angioplasties a stent is implanted to prop open the artery. Unfortunately, in nearly one-third of procedures using a bare metal stent, the artery gets obstructed, or occluded again (restenosis). Because of this, various drugs are now placed on the metal surfaces to lower the rate of restenosis. Despite this, various studies show the restenosis rate is still between 9 and 18 percent. To help with this problem, treatment with drugs like aspirin and/or clopidogrel (Plavix) are recommended  for 6 to 18 months after the procedure to reduce the incidence of restenosis. But    the use of these drugs is associated with the risk of major bleeding. 

Repeat Procedures are Common

An article in the December 2011 issue of the Journal of the American College of Cardiology Cardiovascular Intervention reported that one out of six patients was readmitted to a hospital within 30 days after undergoing an angioplasty procedure in New York state. A repeat angioplasty was done on nearly one third of these readmitted patients, not because the procedure was done incorrectly but due to restenosis or other problems.

An earlier study had found a similar rate of hospital readmissions within 30 days of an angioplasty, and the procedure was repeated in 27.5 percent of the readmitted patients. Readmissions were significantly higher (17.5 percent) in those whose angioplasty was done following an acute heart attack compared with 14 percent in patients who did not have a heart attack.