CAN YOU TREAT CORONARY ARTERY DISEASE HEART ARTERY BLOCKAGE WITH MEDICINE IT DEPENDS

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THE DOCTOR FOUND A BLOCKAGE ON AN ANGIOGRAM

How do you treat people with stable coronary artery disease,that is they have some blockages in the arteries that supply the heart muscle(coronary arteries) but they are generally doing well? A New England Journal article said "it remains unclear whether an initial management strategy of percutaneous coronary intervention (PCI)(that is doing something like angioplasty to open up the artery) with intensive pharmacologic therapy and lifestyle intervention (optimal medical therapy) is superior to optimal medical therapy alone in reducing the risk of cardiovascular events.

Click to Watch a Video Illustrating Coronary Angioplasty and What is Coronary Artery Disease

YOU MEAN YOU DIDNT PUT IN A STENT?

In the very interesting blog of an interventional cardiologist she writes about a conversation she had with a patient after she examined his coronary (heart) arteries with an angiogram and found some blockage. "A conversation after I perform a coronary angiogram: Me: You have a blockage in your artery. Patient: So you put in a stent? Me: No. Patient: You didn't open the blockage? Me: No. You will do better with medicine. Patient: The blockage is still there? Me: Yes. But it was a complicated blockage, and putting a stent in it just wouldn't be the right thing to do. Medication is a better way to treat this. Patient: Medicine? For a blockage?



"It seems intuitive -- Find blockage, open blockage, patient all better. It doesn't quite work that way. In fact, there's a medical trial published last year called the COURAGE trial that found that many patients with stable coronary disease do better with medicines than with angioplasty. There are definitely situations where angioplasty is the right thing to do, but there are others where medicines or surgery are better options".



"Further, any time we place wires, balloons, and stents in a coronary artery, there is a risk. We could tear the artery. We could puncture a hole in the artery, causing blood to accumulate in the pericardium, the sac around the heart. And the dye that we use can cause injury to the kidneys. These are just some of the many possible life-threatening complications.I'm sure there may be a few unscrupulous cardiologists out there who would be willing to put a stent in just about anything. The patient knows the blockage is open and does well, perhaps just as well as if no stent had been deployed, and yet an unnecessary risk has been taken".

Not Quite Common Sense

Optimal Medical Therapy with or without PCI for Stable Coronary Disease