india

Updated: Nov 21, 2019 12:08 IST

New Delhi: Medicines and lifestyle modifications can work as well as invasive procedures such as putting stents or performing a bypass surgery for blocked arteries in patients with severe but stable heart disease, according to a new research.

The study, presented at the American Heart Association (AHA) meeting in the US on Saturday, looked at whether procedures to restore normal blood flow in patients with stable heart disease offer an added benefit over more conservative treatment with aspirin, cholesterol-lowering drugs and other measures.

“For patients with stable ischemic heart disease, but with mild symptoms of angina (chest pain) that doesn’t hamper their routine functions, the best way to treat is targeted medical therapy. It is seen that additional angiography and angioplasty or bypass surgery do not bring any additional benefit in survival or reduction in heart attacks,” according to Dr Upendra Kaul, chairman, cardiology, Batra Hospital and Medical Research Center.

Dr Kaul was one of the investigators from India for the seven-year, 5,179-patient ISCHEMIA study. Dr Balram Bhargava, director general of Indian Council of Medical Research, was the national leading investigator for the study for which India contributed 941 patients. The study was coordinated by iProcess, a contract research organisation based in Bengaluru.

The trial, sponsored by the National Heart, Lung and Blood Institute, involved patients with moderate-to-severe but stable ischemia, a condition in which clogged arteries are not able to supply the heart with enough oxygen-rich blood.

Everyone in the trial received medicines and lifestyle advice, while half also underwent one of the invasive procedures.

According to the findings, a significant amount could be saved annually in health care costs if invasive procedures are done away with. Dr David Maron, a cardiologist at Stanford University School of Medicine and co-chair of the study, estimating that just eliminating unnecessary stenting procedures could save the US health care system $500 million annually.

While the study confirms that in a section of heart patients there may not be the immediate need to perform an angioplasty or a heart bypass surgery to prop open the blocked artery, experts in the field said only the doctor must take a call on whether a patient falls in the safe category or not.

“This has long-reaching implications; we need to be extra careful in not conveying that all patients can be managed with medicines, which is not the case. There’s no immediate need for an angioplasty or a heart bypass when the heart function is normal, and no significant blockage of the main left artery,” according to Dr Praveen Chandra, chairman, interventional cardiology, Medanta, The Medicity.

“And all these patients need to be followed up regularly since even if a patient is in the safe category there is always a possibility that they may become symptomatic at some point and require an invasive procedure,” Chandra added.