A new, landmark study finds heart stents – devices used to open blocked arteries - may not be as effective in the long term as medication in preventing heart attacks. VOA's Carol Pearson has more on the study and how cardiologists are reacting to it.
A stent is a tiny mesh, usually made of metal, inserted into an artery during a procedure called an angioplasty. Stents open clogged arteries.
In the past year, there has been a huge controversy about stents coated with antibiotics. Without additional medication, these stents may actually cause blood clots. But stenting seemed to make sense – if stents allow more blood to flow to the heart, they should reduce heart attacks.
But that is not what Dr. William Boden found. He led a study that shows stents do not reduce a patient's chances of having a heart attack. Dr. Boden presented his study at the annual meeting of the American College of Cardiology in New Orleans.
"I think the results of this study may be profound in terms of how it changes the practice of cardiology in medicine," he said.
Dr. Boden and his team of researchers followed more than 2,200 patients, mostly men, who had a blocked artery and experienced chest pains when they exercised. Half got aggressive drug therapy – medications to reduce cholesterol, high blood pressure and a daily aspirin to reduce blood clots.
The other half got the same drug therapy plus a stent. After four and a half years, the rate of heart attacks and death in the two groups was the same. Cardiologist Steven Nissen, of the Cleveland Clinic, explains.
"What happens when you put a stent in, is you're attracting one narrowing in the artery, but it's not the narrowing that's going to cause the next heart attack,” he says. “It's the plaque developing everywhere else that's going to cause the next heart attack, and that's what medicines treat."
The belief is that stents help blockages in one artery, but medication helps the entire body. Even more surprising, the study found medication was about as effective in relieving chest pain, the main reason for inserting a stent.
Still, cardiologists like Dr. John Reilly say there is a need for stents. "In patients who come in with heart attacks, stenting and angioplasty is clearly the best treatment for those people," he says.
In the United States, more than one million angioplasties are performed annually. Many cardiologists now predict a decrease in angioplasties, procedures that cost tens of thousands of dollars.