Pills as good as stents for stable heart patients: analysis

Treating stable heart patients with a handful of pills works just as well as propping open blocked heart arteries with a stent, U.S. researchers said on Monday, adding to evidence that less-invasive, less-costly drug treatment works as well as implanting a medical device in such patients.

Stents, made by companies such as Boston Scientific Corp, Abbott Laboratories and Medtronic Inc, are still the preferred treatment for opening up blocked heart arteries in patients rushed to the hospital with an acute heart attack.

But several studies have shown the heart devices are no better than drugs in patients with stable heart disease, in which heart arteries have narrowed and may be causing chest pain.

The latest analysis by Dr. Kathleen Stergiopoulous and Dr. David Brown of Stony Brook University Medical Center in New York, published in the Archives of Internal Medicine, attempts to knock down lingering arguments that earlier results were based on outdated technology.

Older analyses had included data from trials comparing drug treatments with balloon angioplasty, in which a balloon-tipped catheter is inserted and the balloon is inflated to open the narrowed passage.

For the latest so-called meta-analysis, the team pooled data only from newer studies that compared drug treatments with stents - a wire-mesh tube used to prop open the artery and prevent it from reclosing.

“The question was is there any benefit to stenting the blockages in these patients as an initial therapy procedure over treating them with optimal medical therapy and referring them to get a stent if necessary,” Brown said in a telephone interview.

How can doctors help blocked coronary arteries?

Doctors can help people with blocked coronary arteries in a number of different ways, depending upon the severity of symptoms experienced as a result.

The majority of people who experience pain owing to a lack of oxygen to the heart muscle (angina) have their symptoms controlled with oral medication and never need to be considered for a more invasive form of treatment.

Those who can be shown to be more severely affected, in that the blockages present are reducing the blood supply to the heart in such a way as to make oral treatment ineffective, may then be considered for other treatments such as angioplasty or coronary artery bypass grafting (CABG).

Angio = blood vessel; plasty = surgical shaping or alteration of. In this procedure a catheter with an inflatable tube is inserted into a blocked or partially blocked coronary artery in order to relieve the blockage.

A CABG procedure utilises a section of the patient’s leg vein to bypass a partial or complete blockage in the coronary artery system.

Occasionally an artery such as the internal mammary artery may also be incorporated into the operation to maximise blood flow to the heart.

The analysis included results on more than 7,200 patients enrolled in eight studies between 1997 and 2005 comparing stents with medical therapy in stable heart patients with narrowed sections in their heart arteries.

“The result showed quite clearly there was no benefit of stenting as far as reducing death, heart attack, repeat procedures and even reducing symptomatic angina (chest pain),” Brown said.

He added that his analysis was the first to include only studies that used stents, and the results offered the most up-to-date comparison of the benefits of stenting procedures with modern medical therapy, which includes aspirin, a variety of blood pressure medicines such as beta-blockers, ACE-inhibitors or angiotensin receptor blockers and cholesterol-lowering statins.


Still, some doctors were not satisfied.

“The meta-analysis published in Archives of Internal Medicine uses old data, from 1995 to 2005, which offer little, if any, new information to guide clinical care,” Dr. Theodore Bass, vice president of the Society for Cardiovascular Angiography and Interventions, a group of heart doctors that specialize in stenting procedures.

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