Many Stent Procedures Unnecessary
Heart Drugs Just as Good at Preventing Heart Attacks, Death in Some People, Study Shows
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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.
Then, about half the participants also underwent angioplasty, usually with stents.
Over the next five years, 19% of those in both groups died or had a heart attack. Similar numbers of people in both groups -- about 12% -- were hospitalized for heart problems.
However, there were some benefits to angioplasty. People who had the procedure were 40% less likely to need another procedure to open up blocked heart arteries. And, particularly in the first two years, they reported better quality of life and less frequent episodes of chest pain.
But over time, some of the differences started to dissipate. By five years later, 74% of people who had angioplasty were angina-free vs. 72% of those who got drugs alone, a difference so small it could be due to chance.