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A large head-to-head comparison of angioplasty and clot-dissolving drugs for heart attack victims has ended in a draw.

The study, performed on more than 3,000 patients, found no difference in the death rate after treatment with the rival approaches at ordinary community hospitals.

During the past decade, clot-busting drugs such as TPA emerged as the front-line treatment for heart attacks, used on about 180,000 Americans at a cost of $350 million annually. If given soon enough, they can break up blockages in the heart's arteries, preventing death or permanent damage.

But more recently, an approach called primary angioplasty has challenged the dominance of these drugs. Angioplasty is already a mainstay of treatment for clogged heart arteries. Doctors push a catheter into the artery and inflate a tiny balloon that squeezes open the blockage to restore blood flow.

The latest study, led by researchers at the University of Washington, was conducted at 19 mostly smaller Seattle-area community hospitals. It was published in today's issue of the New England Journal of Medicine.

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