At risk of a heart attack: a comparison of treatment methods

Heart attacks are dangerous. But not every narrowing of a coronary blood vessel or chest pain will lead to a heart attack. If, however, you are at risk of suffering a heart attack, it is important to consider the scientific evidence for all possible treatments in terms of their effectiveness and any side effects they may have.

Chest pain can be an indication that you are about to suffer a heart attack, meaning a complete blockage in a coronary artery. It can, however, also be the discomfort caused by heart disease (angina pectoris), which is the result of restricted blood vessels. If the pain occurs during times of physical activity or stress, it is referred to as "stable angina". If you experience chest discomfort while resting, you may be suffering from "unstable angina". Recurring and lasting chest pain can be caused by unstable angina, but may also be a symptom of what is known as a non-ST segment elevation myocardial infarction (NSTEMI). Unlike the ST segment elevation myocardial infarction (STEMI), an NSTEMI will not produce any pathological findings in an electrocardiogram (ECG). There are two methods to treat angina pectoris or an NSTEMI: a direct invasive procedure or medication.

The direct invasive procedure is a coronary angiogram performed in hospital. The surgeon inserts a catheter into the patient's coronary blood vessels to identify any narrowing or blockages. To improve blood flow, the surgeon may insert a balloon catheter or stent to expand and support any affected blood vessels. If an area of the artery in question is inaccessible, blood flow is redirected through a vascular bypass.

A series of studies has looked into the advantages and disadvantages of both treatment methods. The studies followed a group of participants for between 6 and 12 months. The participants were adults up to the age of 75 who suffer from instable angina pectoris or have suffered a STEMI, and who have received either direct invasive or medication-based treatments. The study showed that out of 100 adults who were first treated with medications, 8 had a heart attack and 33 complained of persistent chest pains. For those who had undergone direct invasive treatment, 6 out of 100 suffered a heart attack and 21 continued to experience chest pains. Four people died as a result of their condition (both treatment methods).

Out of 100 participants, 4 patients who had initially been treated with medication only and 7 patients who underwent direct invasive treatment experienced subsequent bleeding; 3 patients receiving medication-based treatment and 6 receiving direct invasive treatment suffered a heart attack caused by their treatment; and 29 patients on medication and 22 treated with a direct invasive procedure were hospitalised.

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