Long-Term Benefits of Heart Stents Questioned in Study

Mar 28, 03:09 PM

Current Headlines: By Barnaby J. Feder

Many heart patients routinely implanted with stents to open arteries gain no lasting benefit compared with those treated just with drugs, researchers reported.

The researchers said Monday that patients with stents to prop open coronary blood vessels in addition to being treated with statins and other heart drugs in a five-year trial had better blood flow to the heart than patients treated only with drugs.

But they did not live longer or suffer fewer heart attacks, a finding that confirmed the results of smaller studies.

The researchers also found that the stents were highly successful at improving blood flow and relieving symptoms, including chest pain and shortness of breath, but that the advantage disappeared over time.

"When I saw the results, I was incredulous," said Dr. William Boden, a cardiologist at the State University of New York at Buffalo School of Medicine and Biomedical Sciences, lead author of a report on the study published online on Monday by The New England Journal of Medicine.

The use of stents, which has boomed in the United States in the last 10 years, has come under question. One study showed that stents could save lives when implanted during or shortly after a heart attack but that 50,000 Americans a year had the procedure too long afterward to benefit.

The new study was the first trial to look at a far larger group who had symptoms of clogged arteries and were in no immediate danger. The nearly 2,300 patientsall had a relatively stable form of coronary artery disease that generally progresses slowly.

A majority of Americans who receive stents are in this category, Boden said. They suffer pain or breathlessness when they try to exercise or are under stress because their heart is not receiving enough oxygen, although that condition sometimes shows up only in clinical stress tests.

But they are not believed to be in immediate danger of heart attacks or hospitalization, even though accumulating plaque has narrowed coronary arteries 70 percent or more.

In the new trial, a surprising finding was that after five years more than7 of 10 patients in both groups were free of angina pains, a common symptom of restricted blood flow to the heart muscle, said the researchers, who reported their results at a meetingin New Orleans of the American College of Cardiology.

Previously, doctors had assumed that stents performed much better than drugs at relieving symptoms over the long run. "It's very intuitive that fixing the narrowing with a stent will yield important long-term benefits, but it didn't," said Dr. Steven Nissen, president of the cardiology group.

Nissen, who termed the new study a blockbuster, said it sent a clear message that doctors and patients should feel secure about relying on modern drugs as a "very safe, reasonable and cost- effective strategy" for treating coronary artery disease. The findings raised new questions about the role of angioplasty and stenting, which has been used in 6 million patients around the world since the mid-1990s and is especially popular in the United States.

Close to a million Americans alone a year receive stent implants after angioplasty to create pathways through severe blockages in coronary arteries by inflating tiny balloons in them.

Angioplasty quickly became popular in the 1980s as a less invasive approach for coronary blockages thanopen-heart surgery to construct bypasses around them. Stents improved the procedure by combating the tendency of many vessels to reclose quickly after angioplasty.

Studies have shown that angioplasty and stenting can save lives of heart attack patients. The procedure is also recommended for many patients who suffer from poor blood flow to the heart and are not helped by rest or drugs.

For such patients, the debate is not whether to use stents in addition to drugs but whether stents are used in too many seriously ill patients who might live longer with bypass surgery.

Angioplasty with stenting generally costs $25,000 and up. The latest drug-coated stents cost $2,200 apiece and are especially effective at preserving the channel created by angioplasty.

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