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People in the study were properly tested to ensure they were medically stable, said Dr. Spencer King, a cardiologist at St. Joseph's Heart and Vascular Institute in Atlanta and past president of the cardiology college.
"My greatest fear" is that some patients now may be given medications without adequate testing to show angioplasty can safely be delayed, he said.
The study patients also received an ideal mix of medicines, potentially including aspirin, cholesterol-lowering statins, nitrates, ACE inhibitors, beta-blockers and calcium channel blockers.
Not all patients do, especially when doctors are paid more to do an angioplasty than for the many office visits needed to get the meds right.
"It's a tricky business and it requires a lot of close followup," said Dr. W. Douglas Weaver, a heart specialist at Henry Ford Health System in Detroit and president of the cardiology college.
About 1 million angioplasties are done in the United States each year.
The number started to decline before the study came out, because of safety worries about certain stents, and continued to fall after it, said Dr. Ralph Brindis, a California heart specialist who heads the cardiology college's cardiovascular data registry.
The proportion of angioplasties done on people with chronic but stable chest pain dropped from 18 percent in early 2005 to just over 15 percent by March 2008, the registry shows. Started 10 years ago, it now includes information on about 530,000 angioplasties per year -- roughly 60 percent of the national total.
On the Net:
New England Journal: http://www.nejm.org/
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