Stents no better than drugs for many heart patients: US study

CHICAGO: Many patients with severe but stable heart disease who routinely undergo invasive procedures to clear and prop open clogged arteries would do as well by just taking medications and making lifestyle changes, U.S. researchers reported on Saturday.

If adopted into practice, the findings could save hundreds of millions of dollars a year in healthcare costs, researchers said.

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The US$100 million government-backed study, presented at the American Heart Association (AHA) meeting in Philadelphia, is the largest yet to look at whether procedures to restore normal blood flow in patients with stable heart disease offers an added benefit over more conservative treatment with aspirin, cholesterol-lowering drugs and other measures.

At least two prior studies determined that artery-clearing and stenting or bypass surgery in addition to medical treatment does not significantly lower the risk of heart attacks or death compared with non-invasive medical approaches alone.

Many cardiologists are reluctant to change practice in part because patients who get stents to keep the artery open feel better right away, experts said.

NYU Langone cardiologist Dr. Judith Hochman, who chaired the study, estimated that some 500,000 new patients a year are diagnosed with stable coronary artery disease, in which heart arteries narrowed by fatty deposits cause periodic angina, or chest pain, typically after exercising or emotional distress.

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The AHA and the American College of Cardiology recommend patients with severe narrowing of their arteries have heart bypass surgery or a stent implanted to restore blood flow. Stents are tiny tubes that keep the artery open after blockage-clearing angioplasty.

"There's always been a fear that if you don't do something quickly, they will have a heart attack or drop dead," Hochman said.

The 7-year, 5,179-patient ISCHEMIA study did not show a significant benefit from that course of action.

"For those with mild or no chest pain, there's really not a role for immediately stenting," Hochman said.

Just eliminating unnecessary stenting procedures could save the U.S. healthcare system US$500 million annually, said Stanford University School of Medicine cardiologist and study co-chair Dr. David Maron. He estimates the cost per stenting procedure at about US$25,000 and bypass surgery at US$45,000.

"I would hope this would change practice," said Dr. William Boden of the VA New England Healthcare System, another study author. "We are wasting a lot of money."

The main goal of the trial was an overall reduction in deaths, heart attacks, hospitalization for unstable chest pain or heart failure and resuscitation after cardiac arrest.

On these measures, the addition Read More – Source