blocked arteries that cause chest pain are less likely to cause heart attacks?

[toadspittle]

http://news.yahoo.com/s/ap/20070327/ap_on_he_me/stents_vs__drugs

NEW ORLEANS - More than half a million people a year with chest pain are getting an unnecessary or premature procedure to unclog their arteries because drugs are just as effective, suggests a landmark study that challenges one of the most common practices in heart care.
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The stunning results found that angioplasty did not save lives or prevent heart attacks in non-emergency heart patients.

An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done.

…

Why did angioplasty not help more?

It fixes only one blockage at a time whereas drugs affect all the arteries, experts said. **Also, the clogs treated with angioplasty are not the really dangerous kind.

“Even though it goes against intuition, the blockages that are severe that cause chest pain are less likely to be the source of a heart attack than segments in the artery that are not severely blocked,”** said Dr. David Maron, a Vanderbilt University cardiologist who helped lead the new study.

Can someone explain this? What are the segments that DO cause heart attacks like?

[David_Simmons]

The way I read your cite tells me that your thread title is wrong. The study didn’t say that blocked arteries resulting in chest pains don’t cause heart attacks. It does say that using angioplasty to correct the problem isn’t effective in the long term.

It also says that bypass surgery which jumps the blood supply around the blocked arteries is effective.

Those patients now should try drugs first, experts say. If that does not help, they can consider angioplasty or bypass surgery, which unlike angioplasty, does save lives, prevent heart attacks and give lasting chest pain relief.

[toadspittle]

@David Simmons

The way I read your cite tells me that your thread title is wrong. The study didn’t say that blocked arteries resulting in chest pains don’t cause heart attacks. It does say that using angioplasty to correct the problem isn’t effective in the long term.

It also says that bypass surgery which jumps the blood supply around the blocked arteries is effective.

I know–I wasn’t questioning the primary thrust of the article at all. I’m only curious about that one quote from the cited doctor: that the blocked arteries that are the cause of most chest pain–the ones that doctors target with angioplasties/stents–are NOT a major cause of heart attacks; heart attacks are instead caused by other vessels … (so what are those vessels like, and why do they cause heart attacks?)

[David_Simmons]

This morning’s Los Angeles Times hadthis article on the subject.

In the article there was this, which goes along with what I quoted below from your cite.

In an editorial accompanying the report, Dr. Judith S. Hochman, director of the Cardiovascular Clinical Research Center at the New York University Medical Center, said narrowing of the coronary artery is a marker for more widespread disease. Atherosclerosis is a clogging and hardening of arteries throughout the body, and it is these lesions elsewhere — not the one in the coronary artery — that typically break apart to produce heart attacks and stroke.

It is not surprising, she wrote, that compressing one or a few stable blockages did not reduce the rate of heart attacks.

“Atherosclerosis is a systemic disease, and we need to treat it systemically,” Boden said.

Why did angioplasty not help more?

It fixes only one blockage at a time whereas drugs affect all the arteries, experts said. Also, the clogs treated with angioplasty are not the really dangerous kind.

“Even though it goes against intuition, the blockages that are severe that cause chest pain are less likely to be the source of a heart attack than segments in the artery that are not severely blocked,” said Dr. David Maron, a Vanderbilt University cardiologist who helped lead the new study.

Possibly Dr. Naron was referring to the fact that, since arteriosclerosis affects all the arteries, the probablity is high that the blockage that cause a heart attack came from somewhere else and not from the small section of artery that causes chest pains.

[outlierrn]

http://www7.nationalgeographic.com/ngm/0702/feature1/index.html
not my specialty, but I did read this article recently, pretty interesting, scroll down to paragragh 9-11. Basically acute MI is more likely to come from a rapid plaque rupture than a “stable” narrowing. The former being unpredictable, and thus unaffected by angioplasty.

[toadspittle]

Thanks. That’s very interesting.