Study Casts Doubts on Heart Stents

Mar 27, 06:49 AM

Current Headlines: By From Staff and Wire Reports, The News & Advance, Lynchburg, Va.

Mar. 27--NEW ORLEANS -- More than half a million people a year with chest pain are getting an unnecessary or premature procedure to unclog their arteries because drugs are just as effective, suggests a landmark study that challenges one of the most common practices in heart care.

The stunning results found that angioplasty did not save lives or prevent heart attacks in non-emergency heart patients.

An even bigger surprise: Angioplasty gave only slight and temporary relief from chest pain, the main reason it is done.

"By five years, there was really no significant difference" in symptoms, said Dr. William Boden of Buffalo General Hospital in New York. "Few would have expected such results."

He led the study and gave results Monday at a meeting of the American College of Cardiology. They also were published online by the New England Journal of Medicine and will be in the April 12 issue.

Angioplasty remains the top treatment for people having a heart attack or hospitalized with worsening symptoms. But most angioplasties are done on a non-emergency basis, to relieve chest pain caused by clogged arteries crimping the heart's blood supply.

Those patients now should try drugs first, experts say. If that does not help, they can consider angioplasty or bypass surgery, which unlike angioplasty, does save lives, prevent heart attacks and give lasting chest pain relief.

Lynchburg General Hospital has a nationally recognized heart treatment program which includes rapid access to angioplasty and stents.

Dr. Dan Carey, medical director of the cardiac catheterization lab at Lynchburg General Hospital, said that the group of patients in the newly released study had chronic, stable chest pain, and "are a very different group than one that presents with heart attack or threatened heart attack."

Our emphasis in Lynchburg with cardiac care has been to improve and excel at the care of patients in particular who are in the midst of a heart attack or threatened heart attack -- a very different group than the patients enrolled in this study."

At Lynchburg General, he said, the majority of patients getting stents are those having heart attacks at that moment, a threatened heart attack or already had a small heart attack.

Carey said there's no question that a patient having a heart attack, or threatened heart attack does "benefit from establishing blood flow through the blocked artery as quickly as possible, often with the use of a stent."

"What I find so impressive about the study is the patients who were treated with contemporary aggressive medical therapy, did as well as they did in terms of reducing their risk of subsequent heart attack and stroke.

"The key to reducing your risk of additional heart attack or stroke events is to change the biology of plaques -- and you do that with modifying risk factors with behavioral change and medications."

In the study, only one-third of the people treated with drugs ultimately needed angioplasty or a bypass.

"You are not putting yourself at risk of death or heart attack if you defer," and considering the safety worries about heart stents used to keep arteries open after angioplasty, it may be wise to wait, said Dr. Steven Nissen, a Cleveland Clinic heart specialist and president of the College of Cardiology.

Why did angioplasty not help more?

It fixes only one blockage at a time whereas drugs affect all the arteries, experts said. Also, the clogs treated with angioplasty are not the really dangerous kind.

About 1.2 million angioplasties are done in the United States each year.

Cynthia Pegram of The News & Advance contributed to this report.

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