What’s the best treatment option for patients who have heart disease? The simplest answer is, “It depends.” If you are having a heart attack, prompt treatment with angioplasty can save your life and stop damage to the heart muscle. That answer is clear, and backed up by decades of research. But what about so-called stable heart disease, where your life is not in immediate danger, but symptoms such as shortness of breath and chest pain (often called angina) can take much of the pleasure out of daily life?
The debate about the best treatment strategy for stable heart disease is far from over. But data announced last week provide important information that will help doctors and patients choose whether medications-alone or medications-with-angioplasty is the better option for each patient. Patients with the truly tight blockages got the most benefit from angioplasty. The FAME II study, presented last week at a medical conference in Paris, found that patients who have one or more severe blockages in their heart arteries are more than 10 times as likely to urgently need another procedure to open blocked arteries in the future if they are treated with just medications, rather than with angioplasty.
Fortunately, the doctors who treat blocked arteries (interventional cardiologists) now have a tool that helps them measure how tight a blockage is. Called Fractional Flow Reserve (or FFR), this tool is used during an angiogram. The FFR tool includes a carefully calibrated sensor that measures the blood pressure just above and just below blockage. If the FFR finds the difference between the two measurements is significant, then the best treatment option for that blockage is angioplasty and stenting. If the FFR finds that blood is getting through the blockage and the difference in pressure is not significant, then the better option is to try treating the symptoms with medications alone.
The results of FAME II, while still preliminary, are important because they show how interventional cardiologists can use FFR to help determine which treatment is best for each patient. Stay tuned for more news on this exciting new development in the treatment of cardiovascular disease.
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