DOW JONES NEWSWIRES

Several major medical associations that deal with heart disease Monday issued new criteria for treating patients with clogged arteries and said artery-opening procedures weren't necessary for patients with milder symptoms who weren't treated with drugs.

The panel weighed when it was appropriate to pursue procedures such as bypass surgery or the opening of arteries with catheters, which often involves leaving a tiny stent behind. Such procedures are appropriate, the panel determined, when patients have severe symptoms and are already taking the best-available medication.

The results appear to be in line with a major study called "Courage" that two years ago signaled it was safe to try drug-treatment alone in stable patients before adding artery-opening angioplasty.

That study had a major negative impact on sales of heart stents, where Boston Scientific Corp. (BSX), Abbott Laboratories (ABT), Johnson & Johnson (JNJ) and Medtronic Inc. (MDT) are the major producers.

Gregory J. Dehmer, a representative of a 17-member panel that drew up the criteria of the more recent study, said the findings could improve practices of physicians who find only 60% or 70% of their procedures are appropriate. In developing the criteria, the group studied about 180 clinical scenarios.

"The whole purpose of this document is to get the right treatment for the right patients at the right time, not viewed as increasing or decreasing the number of bypasses done or the number of stent procedures done," said Dehmer, who also is a professor of medicine at Texas A&M University College of Medicine, as well as cardiology, and director at Scott & White Clinic.

Specifically, the panel said it wouldn't be appropriate to send patients for artery-opening procedures if plaque buildup was in just one or two arteries, or if the patient had symptoms only during heavy exercise, had a small amount of heart muscle at risk and wasn't taking medication to help control symptoms.

Dehmer, an interventional cardiologist who implants stents, said at a time when the cost of medical care is a huge concern in the U.S., a goal was to offer patients a more cost-effective approach to medical therapy and to offer physicians a benchmark so they can recalibrate what they are doing in terms of offering the most appropriate treatment.

The panel said it hopes health insurance providers will use the criteria in developing payment and pre-authorization policies.

The criteria, put together by the American College of Cardiology, American Heart Association and other big medical organizations, are designed to address patients who may not have been included in clinical trials.

Also involved in formulating the new criteria were the Society for Cardiovascular Angiography and Interventions, Society of Thoracic Surgeons, American Association for Thoracic Surgery and American Society of Nuclear Cardiology. The criteria have been endorsed by the American Society of Echocardiography, Heart Failure Society of America and Society of Cardiovascular Computed Tomography.

-By John Kell, Dow Jones Newswires; 201-938-5285; john.kell@dowjones.com

(Jon Kamp contributed to this report.)

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