Heart blockages occur when the arteries carrying blood to the heart start narrowing. The heart receives less oxygen than what is required. In the early stages, this reduced supply is mild and inconsistent, which is why symptoms can be inconsistent and hard to pinpoint. Do consult a doctor if you are experiencing the following symptoms:
1.
Fatigue
2.
Shortness of breath during activities that
have not seemed difficult before.
3.
Pressure in the middle of the chest.
In a landmark trial conducted by the researchers from NYU Grossman
School of Medicine and Stanford University, they present some important
findings related to heart blockages and their treatment.
Background of the ISCHEMIA study
Funded by the National Heart, Lung, and Blood Institute, the
ISCHEMIA (International Study of Comparative Health Effectiveness with Medical
and Invasive Approaches) trial studied patients with moderate or severe
ischemia, a condition which occurs when enough oxygen-rich blood is not
supplied to a person’s heart.
The two groups from the trial
Over 5179 patients
from 37 countries were randomized to receive an early invasive strategy of
angiography and revascularization, when necessary, or a conservative strategy
of early optimal medical therapy and angiography, if the medical therapy
failed.
Initial Invasive-strategy
group
According to the trial, ‘Invasive treatment’ meant routine
catheterization, a procedure that slips a tube-like catheter into an artery and
threads it through blood vessels to the heart. This was followed by revascularization
when suited. In the majority of cases, angioplasty was carried out followed by
the placement of a rigid stent. In other cases, blood flow improvement was accomplished
by bypass surgery, where another artery or a vein bypasses the area of
blockage.
Initial
conservative-strategy group
Patients received medical therapy first. Angiography and revascularization
were reserved for people whose symptoms or medical condition did not respond
adequately to medication.
Among patients in the first group, 96% underwent
angiography and 79% underwent revascularization. In the second group, 26% of
the patients underwent angiography and 21% underwent revascularization; 19%
underwent angiography and 15% underwent revascularization before the occurrence
of a primary outcome event.
The total numbers of invasive procedures, including
repeat procedures, that were performed in each group were 5337 in the
invasive-strategy group and 1506 in the conservative-strategy group.
Key findings from the trial
Over a median of 3.2 years, 318 primary outcome events occurred in
the Invasive-strategy group and 352 occurred in the Conservative-strategy
group. The primary outcome events composed of:
- Death from
cardiovascular causes
- Myocardial
infarction
- Hospitalization
for unstable angina
- Heart
failure
- Resuscitated
cardiac arrest
A key secondary outcome was death from cardiovascular causes or
myocardial infarction.
What does the outcome say about heart
blockage
Among patients with moderate or severe ischemia, the researchers
did not find evidence that an initial invasive strategy such as receiving angioplasty
or having stent implants, reduced the risk of heart blockages or death from any
other cause as compared with an initial conservative strategy, where patients
only received medication or minimal surgical intervention.
There were 145 deaths in the invasive-strategy group and 144
deaths in the conservative-strategy group (hazard ratio, 1.05; 95% CI, 0.83 to
1.32).
The researchers recommend that all patients take medications
proven to reduce the risk of a heart attack, be physically active, eat a healthy
diet, and quit smoking.
Is invasive surgery the only way out
of heart blockage?
The ISCHEMIA trial observed that invasive surgeries like
angioplasty or stent implants did not result in reduction of heart blockages as
compared to patients who received only medical therapy. But, are these the only
ways out of a heart blockage?
Enhanced External Counterpulsation, widely known as EECP, is a new
method of treating heart blockages; The procedure is non-invasive and can be
incorporated alongside medical and lifestyle changes, with advice from the
cardiologist.
EECP treatment uses sequential cuff inflation on the calves,
thighs, and buttocks. This is timed precisely with the cardiac cycle. The
process increases diastolic blood flow and raises shear stress along artery
walls.
This action triggers measurable biological changes:
·
Increased VEGF activity, supporting the growth
of new collateral blood vessels
·
Improved nitric oxide synthase activity, which
enhances endothelial function
·
Lower endothelin-1 levels, reducing arterial
constriction
·
Reduced smooth muscle cell proliferation,
slowing arterial thickening
Heal Your Heart, one of India's reputed EECP treatment centers, recognises
EECP therapy as an effective tool in cardiac rehabilitation.
Led by Dr. S. Ramasamy, an internationally renowned non-invasive
cardiac care expert, Heal Your Heart was founded with a clear vision – to offer
patients a scientifically backed, drug-free, surgery-free path to
cardiovascular health. Dr. Ramasamy's decades of specialization in EECP therapy
have positioned the center as a trusted name in evidence-based cardiac care.
Conclusion
The ISCHEMIA trial supports a medication-first strategy as a
reasonable initial option for many stable patients with moderate or severe
ischemia, with angiography and revascularization prescribe, if medical therapy
fails or symptoms remain unacceptable.
For patients seeking non-invasive treatment options, Heal Your
Heart specialise in EECP, a non-invasive procedure for treating your heart
blockages along with medication and lifestyle changes. It offers measurable
benefits in reducing angina recurrence, repeat procedures, and disease
progression.
For More Details About EECP Call : 9003070065 / 9003070064.
ISCHEMIA trial: https://www.nejm.org/doi/pdf/10.1056/NEJMoa1915922
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