RESEARCHES ON MEDICAL MANAGEMENT AND LIFESTYLE CHANGE
There are several studies were carried out by medical science to compare the effectiveness of the two modes of treatments – invasive and non-invasive. At least six such studies have shown that the Angioplasties/stents and bypass surgery are not better than Optimum Medical Treatment combined with lifestyle changes. Lets us discuss the results of these studies.
In 2007 the famous New England Journal of Medicine (NEJM) published the results of research called Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation (COURAGE). Conducted in the USA this randomized Controlled Trial enrolled 2287 severe heart patients – half of them took Aggressive Medical Management and half continues with the same medicines after they got Angioplasty also. The study followed all there more than 2000 people for 4.6 years and found no additional benefit of doing PCTA or Angioplasty. Now the same group of researchers followed these 2000 plus patients for 15 years and still found no advantage of doing Angioplasty on half of the group.
This interesting research study was conducted at London Imperial College and was published in The Lancet in 2017. The research group took 200 patients with severe heart disease with chest pain. They all went for Angiography – in half of them, Angioplasty was done during angiography and in the next half though Angioplasty was not done – but they were informed that Angioplasty was done. Both the groups continued on medicines and were followed for the next 6 weeks – angina and TMT were done on all. Surprisingly there was no difference between the two groups. This study proved that Angioplasties do not produce any benefit over dug treatment even on short term.
BARI 2D Trial:
This study is another example which showed that in heart patients with type two Diabetes Revascularization (Bypass surgery or Angioplasty) was no effective that Optimal medical therapy. This study took 2368 patients of heart disease and divided them into two groups – one went for either Bypass surgery or Angioplasty (about 1100 plus patients) and continued their intensive medical therapy with allopathic medicines. The next half only took only Intensive Medical therapy and did not go for either Bypass or Angioplasty. These patients were followed for the next 5 years and the survival rate was the same. This study showed that the results of Bypass were a little better than Angioplasty. This study was published in 2009 in New England Journal of Medicine (NEJM) and was titled as “Bypass Angioplasty Revascularization Investigation 2 Diabetes” or BARI 2D.
This very important trail called “International Study of Comparative Health Effectiveness with Medical and Invasive Approaches or ISCHEMIA Trial” is another and very recent proof that Lifestyle change with Optimum Medical Treatment is a replacement of Bypass Surgery or Angioplasty. The results of this 10 year US Government-funded 100 million US Dollar study was conducted on more than 5000 heart patients in 37 countries to check whether bypass Surgery/Angioplasty was better than Lifestyle change with medical management. Of the 5179 heart patients with Angiography 2591 went for surgery or stenting and 2588 continued on lifestyle modification with medical management. All the patients were then followed for three and a half years – and a comparison of all parameters (number of deaths, heart attacks, heart failure, Hospitalization) was found to be the same in both the groups. The study results were presented at the Annual Conference of the American heart Association in Philadelphia, the USA on 16th November 2019. The Ischemia Trial created so much of interest in non-invasive therapies and resentment against overuse of Bypass Surgery/Angioplasty that the news created headlines in New York Times, Washington Post, Wall Street Journal, Associated Press and Reuters. In India – Times of India, Hindu, Telegraph, the Week, and major Hindi Newspapers carried out headline articles against the use of Bypass and Angioplasty. Dr. Ambuj Roy (head of cardiology, AIIMS, New Delhi), Dr. Balram Bhargav (Cardiologist, Head of Indian Council of Medical Research) also went on record by commenting on the effectiveness of Lifestyle therapy in the majority of heart patients who are stable.