When to Open Coronary Arteries

Angioplasty – the passage of a catheter from the groin (femoral) artery into a coronary artery to relieve obstruction - is a pretty common procedure these days. However, it seems that there’s a good time and a bad time to open a blocked coronary artery. It’s accepted that opening an artery that’s completely blocked in the first 12 hours after a heart attack can restore the blood flow to the heart muscle, and is a potentially life-saving procedure. Angioplasty after this time is more controversial.

In a study called the Occluded Artery Trial or OAT, NYU School of Medicine researchers examined the benefits of opening coronary arteries 3 to 28 days after a heart attack. The study involved over 2000 patients from centers around the world. They were randomly allocated to one of two groups: balloon angioplasty and stents plus medical therapy, or medical therapy alone. Their subsequent clinical course was followed for 3 years.

Comparison of the findings after 3 years showed that angioplasty made no difference to the frequency of death, recurrent heart attack, or heart failure; indeed, there was a trend towards slightly more frequent recurrent heart attack in the angioplasty patients.

Cardiologists and their patients need to be aware of this study. The results, which are convincing, show that enthusiasm for angioplasty more than 48 hours after a heart attack needs to be curbed, in spite of the technical expertise that may be available.