A new report has shown that patients who use only drugs verses angioplasty or stent surgery initially may take longer to get the blood flow back in patients with clogged arteries but do as well in the later years. Reported in Thursday's New England Journal of Medicine, the study highlights the early advantage that angioplasty had at relieving pain in non-emergency cases reducing within six months and vanishing after three years. Doctors had earlier estimated this effect to last for about five years and the revised information is based on patients own reports of how they did after treatments.

Dr. Eric Peterson, from Duke University who co-authored an editorial in the medical journal said, "This study should be enlightening and practice-changing for doctors and patients alike." He said drugs should be tried before going in for the $ 40,000 procedure. In angioplasty, the surgery, known as PCI for percutaneous coronary intervention, a tiny balloon is used to flatten out a clog and prop the artery open using a mesh tube called a stent. It is the most frequently performed procedure on people having a heart attack or those who have to be hospitalized with worsening heart symptoms.

The Associated Press feels based on figures requested from an American College of Cardiology database that the number of angioplasties being performed have reduced from 18 % in early 2005 to a little over 18 % in March 2008 since the results of this study were released in 2007.

The study called COURAGE, for Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation evaluated 2287 volunteers and reported last year that patients being treated only with drugs for chest pain known as angina and for heart disease are in no way more likely to die or have a heart attack during the follow-up period of 30 to 84 months when compared to people who also received PCI.

Dr. Eric Peterson of Duke University Medical Center in Durham, North Carolina, and John Rumsfeld of the Denver Veterans Affairs Medical Center, wrote, "COURAGE demonstrates that both treatment strategies can have a profoundly positive effect on patients' health status and suggests complementary roles -- optimal medical therapy as first-line therapy, with PCI reserved for patients who do not have a response or who have severe baseline symptoms."

Dr. William Weintraub of Christiana Care Health System in Newark, Delaware, who led the study said, "You can say to patients, 'you won't be at increased risk if we don't put a stent in that blockage right now.”

About 1 million angioplasties are done in the United States each year with at least a third of angioplasties performed on people not in imminent danger, only to relieve chest pain. The researchers estimate that the PCI treatment would significantly benefit 1 out of 17 people when compared with those who got only drugs. The further quantified that for 25 who underwent the PCI surgery, only two would lead a life with significant improvement in quality. 21 % of the patients who were only given drugs ultimately had to undergo a PCI treatment.

Peterson and Rumsfeld said "It is difficult to assert that a PCI-first strategy should clearly be adopted routinely in patients with stable angina." They felt the PCI carried risks and for every 1000 patients who underwent the treatment approximately two would die, 28 would suffer a heart attack associated with the surgery, 60 to 90 would do better, while about 800 would feel no benefit compared to drug treatment.

Dr. William Weintraub of Christiana Care Health System in Newark, Del. and study leader said, "Patients get better," regardless of which initial treatment they have. The exception was in the case of those who had more severe pain to begin with, they did better with angioplasty.

Many feel the positive results were the result of an ideal mix of medicines, cholesterol-lowering statins, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers that were given to them which does not always happen especially when doctors are paid more to perform an angioplasty than a routine office visit.

Dr. W. Douglas Weaver, a heart specialist at Henry Ford Health System in Detroit and president of the cardiology college said, "It's a tricky business and it requires a lot of close follow up."