Many Stent Procedures Unnecessary
Heart Drugs Just as Good at Preventing Heart Attacks, Death in Some People, Study Shows
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
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