Tuesday, March 27, 2007
Stents don't stack up, study says...
Coronary artery stents may be no more effective than medication alone, study says
It was a sunny summer day, and I was at a plastic surgeon's office preparing to shoot a story on new therapies for burn victims. My phone rang, and I politely excused myself. "Hey Dad! What's up?"

"Listen, I don't want to alarm you, but your mother is in the hospital. She's fine, but she's going to have an angioplasty today."

I remember that phone call as if it were yesterday, but in fact, it was almost two years ago.

This morning, I got another phone call from my dad. He wasn't calling to tell me she was back in the hospital, but instead to ask about a new study on angioplasty. He's a physician, so he stays on top of the journals, but he wanted to see how CNN would report it.

The study, published in the New England Journal of Medicine, found that patients with stable coronary artery disease, when treated only with medication fared just as well as those treated with medication and angioplasty. The theory is, if you can accomplish the same thing without surgery, why not just stick to the medication alone? It would theoretically save money for patients and insurance companies, and also avoid surgical risks. (Read the Full Study)

But I had a different take - I told my dad I was glad mom got a stent. Her coronary artery disease wasn't stable. In fact, she went to the doctor's office expecting to get some pain medication for her shoulder, and she left in an ambulance. The shoulder pain was an early sign of a heart attack.

Maybe the idea of a stent seems better to me because you can physically hold it in your hand - you can actually visualize how it would prop open the artery. The drugs do their work microscopically, and I'm sure they do it well, but I guess I'm just more of a visual person.

What do you think? Would you opt for medication alone, or go for the surgical procedure?
"...But I had a different take - I told my dad I was glad mom got a stent. Her coronary artery disease wasn't stable."

The article was about stents placed in patients with stable coronary artery disease, which had nothing to do with your mother, who was acutely unstable (and where stents show a clear benefit).
i agree with the Dr. why would anyone want to wait for the medications to do what the stents can do overnite . if we have the technology to keep a person alive now , why wait. i recently had 3 stents put in in july 06 and i am a new man... Thank god for them!
Dr. Gupta
Many years ago coronary artery bypass surgery was studied in a similar fashion. The CASS study as it is known suggested a similar finding, that patients with single or double vessel CAD and stable angina did as well with medicine as with surgery. Hence the results of this study are not such a great surprise to surgeons.
I had a heart attack at the age of 47. I received three stents as I would not allow a by-pass to be done as my daughter was getting married in nine days. I had a double by-pass 11 months later. Am I for the treatment of stents, you bet I am it gave me the opportunity to enjoy my daughters wedding and put off the by-pass surgery. Stents may not be the answer for everyone, but to me it was. They definately are not the cure. My husband had to have a five way by-pass 11 months after he suffered from a heart attack. But it did us the opportunity to adjust our lives and focus on our health. We both are now doing fabulous.
One of the important effects in the study article itself (although not reported in any news releases I've seen) is that stents did better than medication in women, but not men. Since 85% of the study subjects were men, the aggregate data (which is what's been reported in the media) showed no difference between stents and medications. The small sample size of women in the study kept the gender effect from reaching statistical significance, although it was very close (hazard ratio = 0.65, CI=0.4-1.06).

I feel this is an important effect trend to pay attention to and more research needs to be done on women to see if the effect reaches significance with a larger sample size. Medical research has a shady history of using mostly male subjects and treating their data as applicable to women, which is totally inappropriate. I was disappointed to see this gender effect trend ignored by the media (and honestly by the researchers also).
First, let me say how happy I am for you that your mother received appropriate treatment and is doing well.

But...didn't the study indicate that angioplasty and stents are effective during a heart attack? The study was about stable CAD. Since your mother's condition was not stable, I'm not sure why you would disagree with a study about stable CAD. I think you are just confusing people by saying you disagree based on a different scenario than the study was looking at.

Did I miss something?
I just wanted to quickly weigh in here. First of all, thank you all for your comments! I wanted to confirm that what many of you are saying is true - the study only deals with stable coronary disease.

As you are aware, my mom's situation was acute and certainly, stents are a very effective therapy for acute coronary events.

The thing is, I can't seem to shake this feeling that if somebody I love had stable heart disease - I would want them to have a stent versus medication alone. As I said, maybe it's because I can actually visualize how a stent would hold open an artery, but it just seems like a more permanent solution to me.
I am Matthew's mother and would like to add some additional information to his blog. I would like to address Erin's comment. The stent saved my life. I had a 90% blockage in my LAD. I feel the need to comment, because she has made an excellent point. Everyone knows by now that women have different reactions to impending heart attacks than men. I come from a medical family and was aware of this fact, yet did not recognize my own symptoms. I had been having tingling/burning across my chest, and a shooting pain that started in my RIGHT shoulder, going up my neck, into my head. This only occured when I climbed the steps in my house and upon sitting down, disappeared. I did not have it any other time. It finally occured (not climbing steps) when I was walking outside on a hot August day. This was the first time that I truly took notice. These symptoms had been occuring for weeks. I never suspected heart disease. When the doctor told me I needed to be hospitalized immediately, I actually wondered who he was talking to. Ladies, I was lucky. Please be aware of other unusual symptoms that keep recurring, even if it doesn't fit the norm. Insist upon an EKG. Many doctors dismiss our symptoms until it is too late.
The study wasn't about stents versus medical therapy, it was stents AND medical therapy versus medical therapy alone.

The results of the study concluded that patients who received stents and optimal medical therapy received no added benefit (i.e. fewer heart attacks/strokes, etc) than those who received medical therapy alone.

So even though you are a "visual person" and can "visualize" the stent propping that clogged artery open, it's the lifestyle changes and the medications that are likely doing the real work.

To me, this is sort of like the "Catapult" technology LA Gear came out with in the late 80's and early 90's for their basketball shoes. The concept was cool, you could "visualize" how the spring-like action could theoretically make you jump higher, but did it really give you any extra hops? Or was it really the hours in the gym doing squats, lunges and calf raises that gave your legs the extra lift?

Again, I think stents, when used in the appropriate clinical situations (acute coronary syndromes and unstable angina), are of obvious benefits and should be used without question. But with the burgeoning cost of healthcare, if we can save the American people hundreds of millions, if not billions, or dollars each year, couldn't we then use that money to fund other important projects (such as cancer research)?
How about stents in kidneys?? I never had high blood pressure..then it went off the charts..took forever to bring down..and then finding out kidneys were blocked causing the high blood pressure...all this discovered after a 7 months and then a tia...stent put in rt kidney..left blocked 75%...explain to people this can happen...and why...its not just the heart..but kidneys block too...
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