Friday, November 17, 2017

Are Artery-Opening Stents for Chest Pain a Waste of Time?

A new study suggests that the placebo effect of stents in heart patients with chest pain may be far more pronounced than thought. That could mean that drug therapy alone, rather than the pricey, artery-opening devices, is all that’s needed for certain patients, the researchers said.

“The most important reason we give patients a stent is to unblock an artery when they are having a heart attack. However, we also place stents into patients who are getting pain only on exertion caused by narrowed, but not blocked, arteries. It’s the second group that we studied,” explained lead author Rasha Al-Lamee, from the National Heart and Lung Institute at Imperial College London.

The study included 200 patients with stable angina who received six weeks of intensive drug treatment for their angina. After that, they either received a stent or underwent a simulated procedure where no stent was implanted.

Patients who received stents did not have more improvements in angina or quality of life than those who did not receive a stent. Angina is the medical term for chest pain. It is typically caused by the build-up of fatty plaques in the arteries.

Stents aren’t cheap, either: The devices and their insertion coasts from $11,000 to $41,000 at hospitals in the United States.

The study was published online Nov. 2 in The Lancet medical journal, to coincide with a presentation at a cardiology meeting in Denver.

Writing in a commentary that accompanied the report, two cardiologists said the “landmark” study has implications that “are profound and far-reaching.” “First and foremost, the results of [the study] show unequivocally that there are no benefits” for the use of stents compared to drug therapy for people who have stable angina, said Dr. David Brown, of Washington University School of Medicine in St. Louis, and Dr. Rita Redberg, of the University of California, San Francisco.

In fact, based on the new findings, Brown and Redberg believe that stents may not be useful in these cases even when a patient’s angina fails to get better after medications are used. “Based on these data, all cardiology guidelines should be revised to downgrade the recommendation for [stents] in patients with angina,” whether or not they also received drug therapy, the doctors said.

My Take:
Don’t hold your breath until medical standards reflect these findings. Each year over a half-million patients in the United States and Europe undergo stent treatment. The income derived by both the hospitals and doctors is someplace between 5 and 20 billion dollars annually.

A significant number of these procedures will result in potentially dangerous complications including heart attack, kidney injury, stroke and death. Subjecting these patients to those risks with no benefit is unconscionable.

The Bottom Line:
If you have symptoms of angina please seek cardiac evaluation. Insist on a high-speed CT scan to generate a calcium score before agreeing to cardiac catherization. Finally, do not agree to stent insertion during catherization.

November 2, 2017 National Institutes of Health

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