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To Stent or Not to Stent: Researchers Say It Depends

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Dec. 22, 1999 (Baltimore) -- Use of a device called a coronary stent in people with certain types of heart disease results in less need for additional heart-related procedures, report two studies in the Dec. 23 issue of TheNew England Journal of Medicine. Stents are the tiny wire mesh tubes that are threaded into blocked arteries in the heart and then expanded to create a free-flowing passage for blood.

"As expected, coronary stents increased the diameter of the blood vessels," says Alice Jacobs, MD, professor of cardiology at Boston University School of Medicine, who wrote an editorial accompanying the studies. "They also resulted in less need for repeat procedures to restore blood flow to the heart."

Other benefits seen in these studies included less chest pain, fewer disabling strokes, and fewer heart attacks in those who received stents. "That's why we use stents," says Jacobs. "To reduce the morbidity [complications] associated with some types of heart disease."

One outcome the studies did not show was that stents help people with heart disease live longer. Jacobs says, "I think we're going to have to study many more patients in order to see a benefit [where death rates are concerned] and we'll probably also have to follow them longer, and I believe the benefit will be modest. The stent population is a lower-risk population in general."

One study looked at more than 9,000 procedures done to people with heart disease in Canada over a three-year period. James M. Rankin, of Vancouver General Hospital in Canada and the study's lead author, reports, "The large increase in the rate of coronary stenting during the study period resulted in a significant decrease in the number of heart-related problems such as heart attacks."

The other study compared the use of a stent along with another procedure called balloon angioplasty in people who were having heart attacks with the use of balloon angioplasty alone. In balloon angioplasty, a balloon is inflated to open a blocked blood vessel in the heart.

This study also found that after about six months, those who received the stents had less need for additional procedures. But according to the study's lead author, "One of the most surprising things about our study was that stenting actually resulted in a slight deterioration [worsening] of blood flow rather than improvement," says Cindy Grines, MD, director of cardiac catheterization at William Beaumont Hospital in Royal Oak, Mich.

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