International study backs preventive approach to heart disease


Over a beer or coffee how many senior conversations start with “How many heart stents have you got?” But is “I’ve got more than you” the right answer?

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A global trial has found medicine and lifestyle changes can be as effective as invasive surgery in addressing stable coronary artery disease.

The ISCHEMIA* Research Group – a contingent of more than 50 international medical researchers – analysed comparisons of invasive surgery and conservative surgery patients over more than three years to help form their findings.

The group’s Australian national lead researcher, Professor Joseph Selvanayagam from Flinders University, says conservative early treatment of stable coronary disease is as effective as early coronary angiography (an angiogram is an X-ray of the arteries in the heart; a stent may be inserted as part of the procedure). Revascularisation is restoration of blood flow to the heart, usually via bypass surgery and revascularisation for patients with and without advanced kidney disease.

“We did not find evidence that the initial invasive strategy reduced the risk of ischaemic cardiovascular events such as heart attacks or strokes, or death from any cause.”

Professor Joseph Selvanayagam, Flinders University

Stents vs drugs


“This trial’s results show there is no need to rush patients with stable coronary disease, and moderate-to-severe myocardial ischemia, to invasive coronary angiography,’ Prof. Selvanayagam said.

“It is perfectly safe to treat these patients with cholesterol-lowering drugs, anti-platelet drugs and antianginal drugs, and then monitor their progress.

“We did not find evidence that the initial invasive strategy reduced the risk of ischaemic cardiovascular events such as heart attacks or strokes, or death from any cause.”

Nearly 5200 people (77 per cent male with a mean age of 64) with stable coronary disease and moderate-to-severe ischemia were involved in the ISCHEMIA main trial, which took place in 320 centres across 37 countries.

Professor Selvanayagam says “We can reserve stents or bypass options for patients who struggle with unacceptable side-effects from medications, or who have bad angina despite maximal medical therapies – although even here we have to make it clear to patients they are taking operative options for symptom relief.”

Heart attack or admission for unstable angina, heart failure or resuscitated cardiac arrest, or death from cardiovascular disease occurred in 353 patients in the conservative arm of the trial and 318 in the invasive arm – a difference which the researchers determined was not significant.

The results of the trials were first reported at the American Heart Association meeting last November and have now been published in the New England Journal of Medicine.

* a medical problem in which there is not enough blood flow.


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