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Study questions a common treatment for heart attacks

By Denise Grady

New York Times News Service

Opening a blocked artery with balloons and stents can be lifesaving in the early hours after a heart attack, but a new study concludes that it often does no good if the heart attack occurred three days earlier or more.

The findings should change medical practice, researchers say, and could affect as many as 50,000 patients a year in the United States. They say doctors should stop trying to open arteries in people who had heart attacks days or weeks ago and who are stable and free of chest pain.

Currently, the balloon procedure, called angioplasty, is used in many of those patients, along with stents, devices implanted to prop open an artery. When patients receive treatment late, it is often because they did not realize they had had a heart attack and delayed going to the doctor or hospital. In some cases, doctors may not make the correct diagnosis right away.

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The new study "should change practice, and I believe it will," said Dr. Judith S. Hochman, director of the cardiovascular clinical research center at New York University medical school, and leader of the study, which included 2,166 patients at 217 hospitals in the United States and abroad.

Hochman presented the results Tuesday at a meeting of the American Heart Association in Chicago. The study was published online Tuesday by The New England Journal of Medicine.

Her report is the latest in a series of recent warnings from researchers who suspect that stents are being overused and may even be causing heart attacks and deaths. Manufacturers sell $6 billion worth of stents a year, and cardiologists charge each patient $10,000 to $15,000 to implant them.

The devices, which came into widespread use in the 1990s, are made of either bare metal or metal coated with a drug meant to help keep the artery from closing up again. Recent studies have found that drug-coated stents can increase the risk of blood clots, even years after they are implanted.

Stents have been used increasingly in people with clogged arteries who are not having heart attacks, but some studies suggest that those patients would be better off taking drugs to reduce cholesterol, inflammation and clotting. The reasoning is that artery disease tends to be systemic and extensive, but stents can treat it only in tiny spots.

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