Treatment for Heart Disease Has Improved Since the Advent of Stents

From the WebMD Archives

Sept. 30, 1999 (Atlanta) -- Patients with heart disease who have stents put in their arteries in addition to balloon angioplasty are less likely to die of their heart disease and less likely to need emergency bypass surgery than are patients who receive balloon angioplasty alone, according to a new study.

Balloon angioplasty is done by passing a thin tube, or catheter, into an artery in the groin. The catheter is then maneuvered into the clogged artery and a balloon is expanded. The balloon pushes the cholesterol plaque against the wall of the artery and the vessel is opened up. After the balloon is deflated, a stent -- a small, stainless steel cage -- can then be inserted into the artery to help keep it open.

In an interview seeking objective analysis of the study, Jeffrey Popma, MD, tells WebMD that to prevent sudden reclosure of the artery after balloon angioplasty, "We use stents in 70-80% of our cases." Popma is director of interventional cardiology at Brigham and Women's Hospital in Boston.

In this study, the researchers examined the medical records of more than 360,000 Medicare patients aged 65 and older who received balloon angioplasty in 1994 and 1996. Of these cases, almost 75,000 received stents.

Of those patients, the overall results show a clear decrease in hospital deaths and emergency bypass surgeries, according to the lead researcher of the study, James Ritchie, MD. "In the subset of patients with stents, vs. without, the changes were fairly dramatic," Ritchie tells WebMD. Ritchie is professor of medicine and head of the division of cardiology at the University of Washington in Seattle. The results are published in the September issue of the American Heart Journal.

The findings are no surprise to Popma. "Every single [hospital] has experienced a drop in their emergency [procedures] from 3-5% in 1993-1994 to under 1% [since stenting became available]," he says.

In another interview seeking objective analysis of the study, Michael Savage, MD, notes that new drugs that decrease reformation of the blockage after the procedures are also responsible for this drop in emergency procedures. Savage is director of the cardiac catheterization lab at Thomas Jefferson University Hospital in Philadelphia.

Savage tells WebMD that, although the findings only addressed the short-term success of stents, the devices may improve long-term outcomes as well. "Long-term, the blockage tends to come back [if a stent is not employed]," he says.

Another finding was that patients who received stents had better outcomes at institutions that perform many of these procedures. "Every study published so far shows a clear-cut association between the number of cases and the outcome [with bypass surgery]," Ritchie says.