Doctors Know Best When It Comes To Treating Chronic Coronary Artery Disease

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Treatment for Chronic Coronary Artery Disease

Medication, angioplasty or surgery? For some heart disease patients, there's no clear-cut choice. The key to getting the best care is to follow your individual doctor's advice, new research shows.

The research, conducted at the Heart Institute of the University of SЦo Paulo Medical School in Brazil, appears in the Sept. 5, 2006, edition of the Journal of the American College of Cardiology.

For the study, researchers reviewed data collected during the Medicine, Angioplasty or Surgery Study II (MASS II) to determine how physician-recommended care affected patient outcomes one year after treatment. All patients were diagnosed with severe coronary artery disease affecting at least two blood vessels but not yet causing a loss of heart function. Coronary artery disease occurs when a buildup of cholesterol in the arteries prevents oxygen-rich blood from nourishing the heart muscle.

"We still currently do not know which is the best therapeutic option for patients with multivessel chronic coronary artery disease and a normal ventricular function," said Whady Hueb, MD, PhD, a cardiologist at the University of SЦo Paulo Heart Institute (InCor). "I think our study offers additional information and reassurance for both doctors and patients that, at the end of the decision-making process, what the doctor and patient agree is the best option in most cases really is the best option."

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Dr. Hueb is senior author of the new study and principal investigator of MASS II, a randomized, controlled clinic trial looking for new ways to determine the most effective treatments for people with coronary artery disease.

For the study, 611 patients met with their individual cardiologists for evaluation. The physicians examined them and then, after conferring with a second cardiologist, recommended one of the three potential treatments: medication, noninvasive angioplasty using balloons and/or stents to open clogged arteries, or coronary artery bypass graft (CABG) surgery to reroute blood through new vessels grafted into place.

After the cardiologists made their recommendations, the patients were randomly assigned to receive a treatment. After one year, all records were reviewed to determine the percentages of patients who had died, experienced heart attacks or required additional procedures to treat blocked arteries.

According to the research, patients assigned to receive their physician-recommended treatment showed a significantly lower incidence of problems. In contrast, patients assigned to a different course of treatment experienced a statistically significant increase in negative events (p = 0.02).

The most common

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