"By five years, there was really no significant difference" in symptoms, said Dr. William Boden of Buffalo General Hospital in New York, leader of the study. "Few would have expected such results."



His results were published online by the New England Journal of Medicine and will be in the April 12 issue, 2007.

Angioplasty is the number one treatment for patients suffering from a heart attack or are hospitalized with symptoms. However, most angioplasties are non-emergency, done to relieve chest pain. Why do doctors recommend the drugs? Angioplasty fixes one blockage at a time. Drugs fix all the arteries.

And, the drugs are effective. In the study, one-third of the people treated with drugs ultimately needed angioplasty or a bypass. The drugs were sufficient for two thirds of the case studies.

"You are not putting yourself at risk of death or heart attack if you defer," and considering the safety worries about heart stents used to keep arteries open after angioplasty, it may be wise to wait, said Dr. Steven Nissen, a Cleveland Clinic heart specialist and president of the College of Cardiology.

"Even though it goes against intuition, the blockages that are severe that cause chest pain are less likely to be the source of a heart attack than segments in the artery that are not severely blocked," said Dr. David Maron, a Vanderbilt University cardiologist who helped lead the new study.

The study involved 2,287 patients in the U.S. and Canada who were suffering from substantial blockages, but were medically stable. However, 40 percent suffered a previous heart attack.

After an average of 4 1/2 years, the groups had similar rates of death and heart attack: 211 in the angioplasty group and 202 in the medication group.

Five years into the study showed similar numbers with 74 percent of the angioplasty group and 72 percent of the medication group free from chest pain with "no significant difference," Boden said.

The new study "should lead to changes in the treatment of patients with stable coronary artery disease, with expected substantial health care savings," Dr. Judith Hochman of New York University wrote in an editorial in the journal.

An angioplasty costs roughly $40,000. The drugs used in the study available in generic form.

Maron, the Vanderbilt doctor who helped lead the study, believes that doctors and patients should give the drugs a chance.

"Often I think that patients are under the impression that unless they have that procedure done, they're not getting the best of care and are at increased risk of having a heart attack and die," he said.

Dr. Raymond Gibbons, a Mayo Clinic cardiologist and American Heart Association president, agreed: "This trial shows convincingly that that assumption is incorrect."