Late stenting not helpful

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THE concept of better late than never does not apply when it comes to reopening blocked heart arteries, researchers reported recently.

A new international study found that when doctors try to use stents to prop open a closed artery days after an untreated heart attack, patients do no better long-term than patients who simply received drugs and other ­non-­surgical treatment.

“Our study specifically addresses the ­question of whether, with a complete ­blockage, there is any benefit … after the acute heart attack, to ­opening the artery anyhow,” said Dr Daniel Mark of the Duke University Medical Centre in North Carolina, who led the study.

“I think our comprehensive answer to that is that the benefit is very small and it’s not worth the extra cost of doing the procedure.”

Earlier results from the Occluded Artery Trial or OAT showed that four years after the heart attack, the rate of death, heart failure or a subsequent heart attack was not reduced by a late attempt at removing the blockage.

The new quality-of-life data, reported in the recent issue of New England ­Journal of ­Medicine, show more reasons why opening an artery too long after a heart attack may be a waste of time and effort.

Although stenting offered some ­improvement over non-surgical ­therapy at the four-month mark, a year later, patients were just as unable to walk up stairs, for example,  as those who did not get stents.

The findings also show that “the heart muscle where that artery is blocked is pretty much dead, and it’s not going to help it out by opening the artery,” Mark said.

“The patients studied in OAT did not experience the full benefit of angioplasty and stenting because they received treatment after the heart was irreversibly damaged and no longer able to significantly benefit from the oxygenated blood flow that angioplasty provides,” the Society for Cardiovascular Angiography and Interventions said in a statement.


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