Based on current U.S. guidelines for treating small heart attacks, doctors quickly perform coronary angiography to identify blocked coronary arteries. This procedure is usually accompanied by angioplasty to open a clogged artery or followed by bypass surgery in patients with multiple narrowed coronary arteries.
Results of a recently published Dutch study have questioned this strategy, however. In the study, 1200 patients who had a small heart attack were randomly assigned to invasive treatment (rapid angiography plus angioplasty or bypass) or to medical management alone with medications to prevent the formation of blood clots.
One year after the heart attack both groups had the same mortality rate of 2.5 percent. Immediate heart damage was significantly more common in patients who had the invasive treatment, but more patients who were only given drugs were rehospitalized for angina or chest pain. The authors concluded they could not demonstrate that the invasive strategy was better.
This report probably won't alter the current guidelines for treating small heart attacks in the U.S., at least in the near future. Prominent cardiologists here have pointed that results from more than one study and a longer follow-up period are needed.