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Many Stent Procedures Unnecessary

Heart Drugs Just as Good at Preventing Heart Attacks, Death in Some People, Study Shows
WebMD Health News
Reviewed by Louise Chang, MD

March 26, 2007 (New Orleans) -- Hundreds of thousands of Americans may undergo unnecessary angioplasty and stent procedures to open clogged heart arteries each year, a landmark study suggests.

The long-awaited results show that people with stable coronary artery disease who got common medications to lower blood pressure and cholesterol levels were no more likely to die or to have a heart attack over the next five years than those who also underwent angioplasty with stents.

Of the more than 1.2 million angioplasty procedures performed each year, at least 50% of them are done on an elective basis in people with stable coronary artery disease, says Stephen Nissen, MD, president of the American College of Cardiology (ACC) and head of cardiovascular medicine at The Cleveland Clinic.

In people with coronary artery disease, plaque builds up in the arteries, making it harder for blood to get through, thereby depriving the heart muscle of oxygen. This can lead to chronic chest pain that worsens during exercise and to heart attacks.

During angioplasty, a balloon at the end of a long tube is threaded through an artery in the groin. The doctor shimmies the probe up through the patient's leg and into the arteries of the heart, inflating the tiny balloon at the spot where the vessel has narrowed.

To keep the vessel open, doctors usually add a stent to the end of the balloon catheter. These metal, mesh-like tubes prop open clogged arteries to restore blood flow.

Angioplasty Still Best for Some

The study's results do not apply to people who get stents because they are in the midst of a heart attack or whose chest pain suddenly gets worse, doctors stress. For them, angioplasty is a proven lifesaver.

Additionally, angioplasty is better at relieving the chest pain associated with angina, says researcher William Boden, MD, of Buffalo General Hospital/Kaleida Health in Buffalo, N.Y.

"For an individual patient, angioplasty may still be the best option," he tells WebMD. "But there has been an implication that if you give patients drug therapy rather than angioplasty, you’re giving them less than optimal treatment.

"Now we know that if you opt for medicine, you are not putting patients at risk," Boden says.

The study, known as COURAGE, was released at the annual meeting of the American College of Cardiology and simultaneously published online by The New England Journal of Medicine.

Stent Patients as Likely to Die, Have Heart Attack

The researchers studied 2,287 people with stable coronary artery disease who experienced chest pain for about two years, with an average of 10 episodes per week. All had at least a 70% blockage in one or more heart arteries.

All participants were put on optimal drug therapy, which includes nitroglycerin to control chest pain, beta-blockers to control heart rate, ACE inhibitors for lowering blood pressure, and statins to lower cholesterol. Everyone was also urged to exercise more and lose weight and quit smoking, if needed.

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