Is preventive angioplasty beneficial?

This trial evaluated whether performing preventive percutaneous coronary intervention (PCI) in patients with clogged arteries that did not cause a heart attack has any effect in reducing the risk of death, heart attack of chest pain (adverse cardiovascular events).

Heart attacks occur when a coronary artery (the arteries that supply blood and oxygen to the heart) suddenly becomes blocked by a clot of blood in arteries previously narrowed due to accumulation of fatty materials (coronary artery disease or CAD). Because of the lack of oxygen, the portion of heart muscle supplied by the affected artery will die (infarct artery), unless treated immediately. PCI is a procedure used to unblock the heart blood vessels using small inflatable balloons and stents (small flexible tubes that keep the artery open). In acute heart attacks, the first treatment option is PCI to try and reestablish blood flow in the affected blood vessel in order to minimize the damage to the heart muscle. However, in patients with blocked arteries that did not cause a heart attack, the effect of PCI has not yet been fully studied. This study aims to evaluate the potential benefits of PCI in preventing adverse cardiovascular events in these patients.

This trial involved 465 patients who had a heart attack and needed emergent PCI and who had other coronary arteries that were more than 50% clogged, but did not cause an infarct in their territory yet. After the PCI procedure in the infarct artery (the vessel that caused the heart attack), patients were randomly assigned to either not undergo any procedures (231 patients – the control group) or to undergo preventive PCI in the non-infarct clogged arteries (234 patients – the intervention group). After an average follow up period of 2 years, results showed that the combined rate of persistent chest pain, heart attack or death due to heart disease was reduced by 65% in patients who received a preventive PCI compared to the control group.

In summary, preventive PCI of non-infarct arteries significantly reduced the risk of subsequent adverse cardiovascular events as compared to PCI limited to the infarct artery.

Consult your physician on the possible application of preventive PCI in your situation.