Not All Coronary Heart Patients Need Stents

Initial stent implantation may not offer added benefit to stable coronary artery disease patients

(RxWiki News) Not all stable patients with coronary artery disease will receive an added benefit from initial implantation of a stent to prop open a clogged artery.

A first-time stent was not found to lead to better outcomes as compared to medical therapies such as blood pressure medications or low-dose aspirin in preventing non-fatal heart attacks, chest pain, or bypass operations to restore blood flow or death.

"Protect your heart by taking prescribed cardiac medications."

Drs. Kathleen Stergiopoulos and David L. Brown, of Stony Brook University Medical Center, found that after more than four years, coronary stent implantation in combination with medical therapy for stable coronary artery disease did not significantly reduce the number of deaths, non-fatal heart attacks, chest pain or discomfort, or unplanned revascularization.

During the review study researchers reviewed eight randomized clinical trials comparing first-time stent implantation and medical therapy to initial medical therapy alone. The analysis included 7,229 patients who received treatment between 1997 and 2005. About half received stent placement and medication, while the remainder only received heart medicine.

Of the 649 patients who died during the trials, 8.9 percent occurred in the stent group, while 9.1 percent of those receiving only medications died. An additional 323 patients had non-fatal heart attacks, with 8.9 percent occurring in the stent group compared to 8.1 percent in the medical therapy patients. Unplanned revascularization was performed in 21.4 percent of stent patients and 30.7 percent of participants receiving only medication.

Data on patients with chest pain and discomfort was only available among 4,122. Of those, 29 percent of stent patients experienced chronic chest pain as compared to 33 percent of patients receiving only medical therapy.

A pair of other recent review studies found that initial stent placement reduced mortality, and chest pain and tightness. Investigators suggest their findings may have differed because the new analysis was limited to studies in which stent implantation was the primary form of unclogging arteries.

Unlike previous review studies, investigators excluded studies in which balloon angioplasty was used as the primary means for opening arteries.

"The exclusion of studies using balloon angioplasty as the primary form of PCI (percutaneous coronary intervention) shifted the years of enrollment forward by almost a decade during which time optimal medical therapy evolved to the current regimen that includes aspirin, beta-blockers, ACE-inhibitors (or angiotensin receptor blockers) and statins," the researchers wrote.

"In the context of controlling rising health care costs in the United States, this study suggests that up to 76 percent of patients with stable CAD (coronary artery disease) can avoid PCI altogether if treated with optimal medical therapy, resulting in a lifetime savings of approximately $9,450 per patient in health care costs."

The study was recently published in the Archives of Internal Medicine.

Review Date: 
March 1, 2012