• What to Do When Your Heart Disease Is “Stable”: For Many Patients, Open Arteries Are Better Than Closed Arteries

     
     
     
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    Date: 8/28/2012

     

    According to the most current study published on the treatment of stable coronary artery disease, when a stable heart disease patient has one or more “tight” blockages, the best treatment option is angioplasty and stenting  plus medications.  This study, called FAME 2, found that stable heart disease patients with “tight” blockages who were treated with angioplasty and stenting and the best available medications had better outcomes than patients who received only the medications. The patients who received the angioplasty and stenting were significantly less likely to require an unplanned hospitalization leading to urgent revascularization (angioplasty) to stop a heart attack  or control symptoms that had became unstable. In addition, they felt better and were less likely to need medications for their chest pain.

    In this recent study, doctors measured the severity of the blockages in patients’ heart arteries using a test called fractional flow reserve (FFR).

    What Is Fractional Flow Reserve?

    During a cardiac catheterization procedure (or diagnostic angiogram), interventional cardiologists may use Fractional Flow Reserve (FFR) to measure how “tight” a blockage is. FFR is determined by a carefully calibrated sensor that measures the blood pressure upstream and downstream of a blockage after the administration of adenosine, a medicine that increases blood flow in the heart. Because a tight blockage restricts blood flow, the pressure downstream is lower than the pressure upstream. If the FFR finds the ratio between the two measurements is significant, then the blockage is confirmed to be tight. FFR is considered to be complementary to a conventional angiogram, particularly when the tightness of a blockage is difficult to establish by angiography or when patients have not had non-invasive stress testing.

    In the FAME 2 study, the severity, or "tightness," of a patient's blockages was confirmed by an FFR. All of the patients enrolled in the study had at least one tight blockage determined by having an FFR of less than 0.8. The patients were randomly assigned to receive angioplasty and stenting while taking the best medicines for heart disease or to continue taking the best medicines alone. Patients with tight blockages did worse with medicines alone as compared to the group who underwent angioplasty with stenting.

    To learn more about FFR, click here.

    What Is Angioplasty and Stenting?

    Angioplasty is a procedure designed to restore normal blood flow through clogged or blocked arteries, which can lead to heart attack, stroke and other serious cardiovascular problems. During angioplasty a thin tube called a catheter is threaded through a blood vessel to the site of a blockage. The catheter has a balloon on its tip that is expanded to push the plaque (the fatty substance that is causing the blockage) out of the way. The goal is to reopen the blood vessel to as close to a normal diameter as possible, allowing blood to flow freely.

    What Questions Should I Ask My Healthcare Provider About My Stable Heart Disease?

    1. What does my chest pain (angina) mean for me? What can we do to manage or eliminate my chest pain?
    2. Do I have any truly "tight" or severe blockages?
    3. What are my treatment options? What combination of lifestyle, medications, and in-hospital treatments/surgery may be necessary to combat the disease?
    4. Will I be able to have my desired quality of life? What can I do to improve the odds of this?
    5. How long is my recovery expected to take? And am I a good candidate for a cardiac rehabilatation program?

    What should I do if I have more questions?

    Ask them. Any time you have a healthcare decision to make, the conversations you have with your doctor are the key to successful results. Be sure your doctor is aware of all of your symptoms as well as all of the medications, vitamins, and supplements you may be taking. And ask every question you have.

    Want more info? To learn more about stable heart disease, including additional questions you may want to ask your healthcare provider, download and print the latest educational resource from SecondsCount. Click here to check it out!

    Note: The information contained herein does not, and is not intended to, constitute comprehensive professional medical services or treatment of any kind. This information should not be used in place of medical diagnosis or medical advice and must be considered as an educational service only.