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Stent Procedure Rivals Bypass in Preventing Heart Attacks

April 16, 2001|THOMAS H. MAUGH II | TIMES MEDICAL WRITER

Inserting a wire stent to keep a coronary artery open during angioplasty is nearly as effective as bypass surgery in preventing heart attacks in the first year following the procedure, according to Dutch researchers.

About 600,000 coronary artery bypass procedures are performed in the United States each year; 300,000 to 400,000 people have one or more stents installed. There is an ongoing controversy among physicians about which is the better procedure.

A team led by Dr. Patrick W. Serruys of Erasmus University in the Netherlands enrolled 1,205 heart patents at 67 medical centers around the world, randomly assigning half to receive a bypass and half to receive angioplasty. In angioplasty, a balloon is inflated in the clogged artery to reopen it--and a stent is sometimes inserted to keep the artery open. Vice President Dick Cheney recently underwent such a procedure after he suffered chest pains from a blockage.

The researchers reported in the April 12 New England Journal of Medicine that, after one year, there was no significant difference between the two procedures in the incidence of death, stroke and heart attack. Nearly 21% of the stent recipients needed to have bypass surgery within the year after their implant. That contrasted with only 3.8% of the bypass patients who needed a second operation.

Even so, stenting still cost less per patient. According to the American Heart Assn., the average 1995 price of a bypass was $44,820, contrasted with slightly more than $20,000 for implanting a stent. The study was funded by Cordia Corp., which manufactures stents.

Study Gives High Marks to Bladder Drug

A new version of a 30-year-old drug used to treat incontinence is more effective in treating the condition than a competing drug, according to a first-ever study that compared the two treatments.

Overactive bladder, which is marked by urinary urge incontinence, urgency and frequency, affects an estimated 17 million mostly elderly people in the United States.

Oxybutynin chloride, which is sold under the brand name Ditropan, is an effective treatment, but many people stop taking it because of dry mouth and other side effects. The extended-release version, Ditropan XL, was designed to minimize those effects. A newer drug, tolterodine tartrate, or Detrol, was also developed to minimize undesirable side effects.

A team headed by Dr. Rodney A. Appell of the Baylor College of Medicine in Houston studied 276 women and 56 men with overactive bladder. Participants had between seven and 10 episodes of incontinence each week and urinated 10 or more times per 24 hours. Half received Ditropan XL, half Detrol.

The team reported in the April Mayo Clinic Proceedings that Ditropan XL was significantly more effective at reducing all the symptoms of overactive bladder and that the two had a similar incidence of dry mouth and other side effects. The study was funded by Alza Corp., which manufactures Ditropan XL.

Supplement Helps Some Ataxia Sufferers

Columbia researchers have found the first effective treatment for one form of hereditary ataxia, a rare genetic disorder that affects coordination. Patients have difficulty with balance, speech and coordination of arms and legs. Some patients develop seizures.

Dr. Salvatore DiMauro and his colleagues at Columbia University in New York reported in the journal Neurology last week that some patients with ataxia have a decreased level of coenzyme Q10, also known as ubiquinone--about 70% lower than normal. They gave daily supplements of ubiquinone to six patients and observed a 25% improvement on a scale measuring impairment due to ataxia. Five of the patients were unable to walk before therapy but could walk with assistance afterward. One was able to work outside the home for the first time in her life. The patients did not have Friedrich's ataxia or the major forms known as SCA1 through SCA5.

Blood Pressure Drug Used for Addiction

An old medication used to treat high blood pressure may be useful in helping patients to kick their cocaine habit, according to Pennsylvania researchers. The drug is propanolol, and it is thought to work by blocking the anxiety-producing effects of adrenaline. People suffering through cocaine withdrawal are often more sensitive to adrenaline, which can heighten anxiety in stressful situations and undermine treatment.

Dr. Kyle Kampman of the University of Pennsylvania School of Medicine and his colleagues studied 108 cocaine addicts. During the eight-week study, all received twice weekly counseling; half received propanolol and half a placebo. The team reported in the April issue of Drug and Alcohol Dependence that patients receiving propanolol stayed in treatment significantly longer and were less likely to use cocaine.

Older Fathers Linked to Kids' Schizophrenia

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