Early coronary angioplasty
Does it work?
We don't know. Some studies have shown that having this procedure as soon as possible after an attack of unstable angina can reduce your risk of having a heart attack or of dying. But the research has looked only at what happens to people in the months afterwards. There aren't any studies that have followed people for a longer time.
It may be that certain people do better with this procedure, such as those at high risk of having a heart attack, while others do better with drug treatments.
What is it?
Early coronary angioplasty is a procedure that widens your coronary arteries. That means blood can flow more easily to your heart again, and your heart can get more oxygen. 'Early' means having this procedure soon after you've had an attack of unstable angina.
During the procedure, a doctor uses a tiny deflated balloon on the end of a thin tube. This tube is put into your body, probably near your groin. It is then passed through your blood vessels until it reaches the part of your artery that is blocked.
The doctor then inflates and deflates the balloon several times. This widens the artery and gets blood flowing through it again.
We've prepared some extra information for people thinking of having this operation. To read more, see Coronary angioplasty.
At the moment, experts are discussing whether everyone with unstable angina should have this procedure as soon as possible after they are diagnosed with unstable angina, or whether it should be used only for people who have a high risk of having a heart attack.[1]
At present, doctors in the UK are advised to use this procedure as soon as possible in people with unstable angina who have a high risk of having a heart attack or of dying as a result of their coronary artery disease.[2] To find out how doctors determine risk, see Unstable angina: working out your risk.
How can it help?
We don't know if having coronary angioplasty can help if it is done early on for people with unstable angina. Different studies say different things.
Recent studies have looked at having the procedure as soon as possible, and within a week, of an attack of unstable angina. Compared with drug treatment, this procedure:
- Reduces the risk of having a heart attack or of dying in the four months to six months afterwards.[1] [3]
- Reduces the risk of having more attacks of unstable angina in the four months afterwards.[4]
- Does not affect the risk of having a heart attack or of dying in the 12 months afterwards.[4]
Older studies, though, show that having this operation early on doesn't help in any way.[5] [6] [7]
Why should it work?
This procedure can get rid of the blockage that caused your unstable angina. It lets more blood reach your heart. It also widens the narrowed artery or arteries in your heart. In the long run, this means that more blood can flow to your heart. This may help to prevent more attacks of unstable angina or a heart attack.
Can it be harmful?
All procedures carry some risks.
The most recent studies all found that the risk of bleeding during the procedure was about twice as high as the risk with the usual treatment with drugs.[1] [3] [4]
- Around 2 to 8 in 100 people got serous bleeding with coronary angioplasty.
- But only about 1 to 4 in 100 people got serious bleeding with the usual treatment with drugs.
There are some other risks too.
- You may have pain in your chest during the procedure. You may also feel discomfort where the tube is put in. But painkillers will help.
- Sometimes doctors have to give up during the procedure because they can't get the tube into the coronary artery. But this is rare.
In a few people, the coronary artery that has been reopened quickly closes off again.[8] But this is far less of a problem than it used to be. That is because, these days, doctors usually put in a tiny tube called a stent to keep the artery open.
But if your artery does close off again, your doctor may recommend emergency surgery on your heart. This is called a coronary artery bypass graft (CABG for short). The surgery makes new routes for your blood to go around the blocked arteries by taking blood vessels from another part of your body (probably your leg) and attaching them to the narrowed arteries. This allows your blood to go past the blocked sections of your arteries and deliver oxygen and nutrients to your heart muscles. To learn more, see Coronary artery bypass.
References
- Cannon CP, Weintraub WS, Demopoulos LA, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. New England Journal of Medicine. 2001; 344: 1879-1887.
- European Society of Cardiology. Management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European Heart Journal. 2002; 23, 1809-1840.
- FRISC II Investigators. Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. Lancet. 1999; 354: 708-715.
- Fox KAA, Poole-Wilson PA, Henderson RA, et al. Interventional versus conservative treatment for patients with unstable angina or non-ST-elevation myocardial infarction: the British Heart Foundation RITA 3 randomised trial. Lancet. 2002; 360: 743-751.
- TIMI IIIB Investigators. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction. Results of the TIMI IIIB trial. Circulation. 1994; 89: 1545-1556.
- Anderson V, Cannon CP, Stone PH, et al, for the TIMI IIIB Investigators. One-year results of the thrombolysis in myocardial infarction (TIMI) IIIB clinical trial: a randomized comparison of tissue-type plasminogen activator versus placebo and early invasive versus early conservative strategies in unstable angina and non-Q wave myocardial infarction. Journal of the American College of Cardiology. 1995; 26: 1643-1650.
- Boden WE, O'Rourke RA, Crawford MH, et al, for the VANQWISH Trial Investigators. Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. New England Journal of Medicine. 1998; 338: 1785-1792.
- GUSTO II b Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. New England Journal of Medicine. 1997; 336: 1621-1683.
Glossary
- heart attack
- Doctors call a heart attack an acute myocardial infarction (or acute MI). This is the name for the damage that occurs to the heart muscle if it isn't getting enough blood and oxygen because a branch of the is blocked. During a heart attack, you may have pain or heaviness over your chest, and pain, numbness or tingling in your jaw and left arm.
- coronary arteries
- Coronary arteries are the vessels that supply blood to the heart muscle. If yours are blocked, you may have a pain in your chest (known as ) or a heart attack (what doctors call an ) because parts of the heart are not getting enough blood and oxygen.
- coronary artery disease
- This is when clumps of fat (called plaques) build up on the smooth lining of the arteries supplying the heart with blood (the coronary arteries). Over time, these plaques make the arteries narrower, stiffer and rougher. This is called atherosclerosis. Less blood can get through the narrowed arteries which means less oxygen gets to the heart. This can result in or a .
© BMJ Publishing Group Limited ("BMJ Group") 2007. All rights reserved
This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.
