It's not as routine as having your teeth cleaned, but a growing number of people are going to hospitals to get their heart arteries unclogged and going home the same day.
New research presented by Canadian researchers Sunday at an American Heart Association conference suggests a new approach to angioplasty makes it safe to send patients home the same day. Complications were no greater for those who went home a few hours afterward than for those who were hospitalized overnight.
"This is the kind of study that's going to turn the trend" and get more doctors to try it, said Dr. Timothy Gardner, a Delaware cardiologist who heads the meeting committee but did not have a role in the research.
Angioplasty is one of the most common medical techniques in the world. About 600,000 are done each year in the United States alone.
Through an artery in the leg near the groin, doctors snake a tube to blockages that are clogging vessels and preventing them from supplying enough blood to the heart. A tiny balloon is inflated to flatten the crud, and a mesh scaffold called a stent is left behind to prop the artery open.
Two kinds of complications can occur: bleeding from the leg incision and reclogging of the heart artery.
To avoid the first problem, Canadian researchers led by Dr. Olivier Bertrand of Laval Hospital Research Center in Quebec did angioplasty a different way, using an artery in the arm near the wrist instead of one in the leg, which greatly reduced bleeding.
Next, they tested the need to keep patients overnight by giving half the patients in their study a single dose of anti-clotting medication and sending them home 4 to 6 hours afterward. The other half got standard treatment: the single dose plus a 12-hour intravenous one given overnight in the hospital.
Six months later, the rates of major bleeding, heart attacks or need for repeat procedures to treat blockages were nearly identical in the two groups: 30 among the 504 patients given the single drug dose versus 28 in the other 501 patients.
The combination of arm angioplasty and single-dose drug treatment "is extremely safe," Bertrand said.
The study was funded by Eli Lilly and Co., Bristol-Myers Squibb and Sanofi-Aventis, makers of ReoPro, the anti-clotting drug used in the experiment. Bertrand said he had no financial ties to any of the companies.
Outpatient angioplasty is common in France, Japan, Canada, Germany, much of South America and Australia, and is growing in popularity around the United States.
Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute, thinks it's a good trend for people with simple, routine blockages in non-emergency situations.
"It helps reduce costs of unnecessary hospitalization," she said. Lowering hospital costs can offsets the expense of drug-coated stents that in recent years became the standard of care because they cut the chances that an artery will reclog. That risk is now less than 0.1 percent, Nabel said.
But many doctors remain leery of outpatient angioplasty.
"My view is that we're not ready for that," said Dr. Eric Topol, a cardiologist at the Cleveland Clinic.
The arm approach holds a lot of promise, but doctors will be reluctant to learn it because they've all been trained to use the leg artery, Topol said.
The Society of Interventional Radiology's guidelines note that studies so far have found no greater rate of complications, but the group still recommends that angioplasty patients be kept overnight.
Also at the conference, Dr. Volker Schachinger and colleagues from Goethe University in Frankfurt, Germany, reported encouraging results from the first large, rigorous test of giving patients injections of stem cells from their bone marrow to try to repair damage caused by a heart attack.
In the study of 200 people, those who received the marrow cells had about a 6 percent improvement in heart pumping capacity four months later versus a 3 percent improvement for those given a dummy treatment.
However, specialists cautioned that there was no way to tell whether the marrow cells or something else had caused the improvement, or whether it would last.