Treating More Than 'Culprit' Blockages

Wednesday, 13 Nov 2013 09:18 AM

By Dr. Crandall

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People who have suffered a severe heart attack have a much better chance of avoiding life threatening complications if they not only undergo angioplasty to eliminate the blockage that caused the attack, but have other blockages treated as well.
 
This was the conclusion of a randomized trial called the Preventive Angioplasty in Myocardial Infarction (PRAMI) Trial, which was stopped early because the results were so clearly positive for the preventive procedure, according to the New England Journal of Medicine.
 
An angioplasty involves the insertion of a balloon-tipped tube to widen a partially blocked
artery, after which a stent is inserted to keep it propped open. While this is being done, the doctor can also see if other arteries are blocked.
 
In the trial, 465 patients underwent emergency angioplasty for serious heart attacks. Those who also had blockages in other blood vessels were randomly treated just before the procedure; 234 patients received “preventative” angioplasty, while 231 had only the “culprit” blockage removed.
 
Over a two-year follow-up period, only 21 patients in the preventative group died, suffered a
heart attack, or developed related heart problems. On the other hand, 53 of the patients who received the “culprit only” treatment developed such problems. This amounted to a two-thirds reduction in risk, the study’s authors said.
 
Years ago, we used to treat patients in this preventative manner, before insurance companies decreed that doctors could only treat the “culprit” blockage. Hopefully, this study will help pave the way so that we can again treat patients for more than one blockage at a time.
 
 

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