Study challenges use of invasive coronary surgery

PHILADELPHIA — People with severe but stable heart disease from clogged arteries might have less chest pain if they get a procedure to improve blood flow rather than just giving medicines a chance to help, but it won’t cut their risk of having a heart attack or dying over the following few years, a big federally funded study found.

The results challenge medical dogma and call into question some of the most common practices in heart care. They are the strongest evidence yet that tens of thousands of costly stent procedures and bypass operations each year are unnecessary or premature for people with stable disease.

That is a different situation than a heart attack, when a procedure is needed right away to restore blood flow.

For nonemergency cases, the study shows “there’s no need to rush” into invasive tests and procedures, said New York University’s Dr. Judith Hochman.

There might even be harm: To doctors’ surprise, study participants who had a procedure were more likely to suffer a heart problem or die over the next year than those treated with medicines alone.

Hochman co-led the study and gave results Saturday at an American Heart Association conference in Philadelphia.

“This study clearly goes against what has been the common wisdom for the last 30, 40 years” and might lead to less testing and invasive treatment for such patients in the future, said Dr. Glenn Levine, a Baylor College of Medicine cardiologist with no role in the research. Some doctors still might quibble with the study, but it was very well done “and I think the results are extremely believable,” he said.

About 17 million Americans have clogged arteries that crimp the heart’s blood supply, which can cause periodic chest pain.