PLATTSBURGH — A recent medical study on the use of angioplasty to manage severe but stable chest pain does not contradict existing guidelines on how patients suffering from angina should be treated."There seemed to be some understanding that the investigators contradicted the existing clinical practices," said Dr. William Bradley in response to news reports that suggested the study proved doctors were wrong in using angioplasty to reduce the potential for a patient with chest pain of having a severe or fatal heart attack."In reality, their findings reinforced existing clinical practices."The study, said the interventional cardiologist, who performs angioplasties at CVPH Medical Center in Plattsburgh, actually echoes existing guidelines that doctors follow for the treatment of patients who have chronic but an unchanging level of chest pain.Guidelines, identified by leading authorities on heart disease, recognize the benefits of angioplasty used in conjunction with medications but do not recommend using angioplasty as an alternative to medicine.It is also recognized as an option to medicinal therapy that does not seem to be alleviating chest-pain symptoms, Bradley said."If people are dissatisfied with the level of pain they are having or the restrictions in life they may have because of the chest pain and would like to do more (than taking heart medicine), then angioplasty is an effective way of reducing symptoms," he said."But if you come in to see me while on medication for stable angina, I can't tell you that you are going to live longer if you have an angioplasty. It's very effective for symptom relief, but we haven't been suggesting this replaces medicinal therapy."Angina is usually caused by blocked arteries leading into the heart. Anti-clotting medications — such as aspirin — help blood flow more smoothly and can reduce chronic pain associated with the blockage.Angioplasty allows doctors to place a small tube, called a stent, into the artery to correct the blockage and allow blood to pass into the heart without disruption.The clinical study, released online by the New England Journal of Medicine and scheduled for publication in an April 12 edition, showed that the procedure does not save lives or prevent heart attacks for people with non-emergency situations.But it also noted that angioplasty can be used to manage chest-pain symptoms for patients who have not responded well to medical therapy."These medicines are very potent," Bradley said. "But sometimes it may come to a point where a patient can't tolerate the treatment or is unresponsive to the therapy. Angioplasty is a recognized alternative in those situations."Angioplasty is still an important tool for doctors in treating patients having major heart attacks and has been credited in saving the lives of dozens of North Country residents since CVPH began offering the procedure a few years ago, he said.The majority of the 600 angioplasties performed at the hospital have been non-emergency cases, and Bradley said the staff at CVPH stands by its efforts to provide thorough coverage for patients with heart disease."Angioplasty is a very predictable procedure when done in a skilled facility with trained operators and staff," he said. "Over the last five to six years, there have been tremendous refinements in the technique, and we continue to fine-tune things to learn what benefits our patients the most."Clinical guidelines established for doctors identify several-dozen issues relevant to chest pain and treatment, he added. The issue of angioplasty for symptom relief is only one section of the extensive guidelines.
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