Entries in Stents (5)


Study: More Heart Patients Should Get Stents 

Hemera/Thinkstock(NEW YORK) -- The latest salvo in the battle over stents -- the tiny mesh sleeves designed to keep clogged coronary arteries open -- came in the form of a study suggesting that the devices are better for some patients than medicines alone.

In a new multi-center study called FAME II, which examined outcomes of 888 patients with a significant blockage of least one coronary artery, researchers used a new measure -- known as fractional flow reserve, or FFR -- to decide if a patient should get a stent or not.

The study authors suggest that FFR could help doctors figure out whether a patient's coronary artery blockage is going to put them at risk for a heart-related emergency, such as a heart attack or severe chest pain.

The trial was stopped early because it quickly became clear that those who had not received stents required more hospitalizations and emergency procedures and experienced more heart attack symptoms than their stented counterparts. By the time the study was halted, 12.7 percent of patients without stents had experienced one of these cardiac events, while only 4.3 percent of people who received stents had.

The study was published Tuesday in the New England Journal of Medicine to coincide with its presentation at the annual meeting of the European Society of Cardiology in Munich, Germany. The research was supported by St. Jude Medical, a company that manufactures FFR assessment products and other heart-related devices.

"Stable coronary disease is a very common problem, and there is certainly room for improvement, and using FFR appears help guide stent placement," said lead study author Dr. William Fearon, an associate professor of medicine at Stanford University Hospital.

However, the new study is unlikely to end the debate over the use of stents, which has raged since a landmark study in 2007 known as the COURAGE trial. This study looked at all patients who required a coronary artery catheterization for symptoms of heart trouble. What it found was that less-invasive medical therapy -- in other words, using drugs to control heart risk factors -- was better than the more-invasive stent approach.

In 2009, a new trial -- known as FAME I -- reignited the stent debate. Previous trials, such as COURAGE, relied on a long-used diagnostic procedure known as angiography to assess the severity of coronary artery blockages. The researchers behind FAME I said that their findings showed that FFR painted a more accurate picture of who needed stents and who did not. Many criticized this trial, however, because it included patients who were actually having heart attacks -- patients who had been excluded in COURAGE. Additionally, it did not compare stenting to the standard practice of medical therapy.

Fast forward to FAME II -- a study that attempted to exorcise these demons by offering a comparison of FFR to medical therapy.

"I think that, based on COURAGE, many physicians are treating these patients with medical therapy alone," lead author Fearon said. "While it may be appropriate in some, others would benefit from intervention. This study shows that we can best identify those patients by FFR and will enable more appropriate care."

Some doctors not involved with the research agreed that FFR could be a very useful tool in determining the severity of a patient's heart disease.

"Fractional flow reserve (FFR) is a powerful, invasive tool that can pick out blockages that, at least at the time at which they are being studied, are sufficiently severe as to be able to prevent a safe and healthy increase of blood flow to the heart and can distinguish them from blockages that are not," said Dr. Brian O'Murchu, associate professor of medicine and associate director of the cardiac catheterization laboratory at Temple University in Philadelphia. "In this way, it gives much the same information as is provided by stress tests that include imaging of the heart."

"Recent pressure based on the COURAGE trial to reduce overall stent usage has made an early revascularization strategy less clear," said Dr. George W. Vetrovec, a professor of medicine in cardiology at Virginia Commonwealth University. "FAME II provides, I believe, an important counter argument in patient management for stable but symptomatic coronary disease."

Yet, some doctors remain cautious about these results.

One of these physicians is Dr. Harlan Krumholz, professor of medicine and investigative medicine at Yale University. Krumholz said that the new study falls short of proving that stents prevent heart attack and death.

"[T]he rates of death and the rates of [heart attack] were similar in the two groups," Krumholz said.

Others agreed. "I do not think that this trial should change practice," said Dr. Raymond Gibbons, professor of medicine at the Mayo Clinic. "Try medical therapy first. If your symptoms don't improve, then discuss the risk and benefits of stents with your physicians. Realize that stents do not reduce the rate of heart attack and death."

Copyright 2012 ABC News Radio


For Coronary Artery Disease, Meds as Effective as Stents

iStockphoto/Thinkstock(NEW YORK) -- Inserting stents to open a blocked artery is a common way to treat coronary artery disease. But increasing evidence suggests the procedure is not as beneficial as patients and some doctors might believe.

An analysis published Monday in the Archives of Internal Medicine found that using stents to repair arteries narrowed by plaque was no better than using standard medications to treat patients with stable coronary artery disease.

Patients with the condition usually have angina, or chest pain, at certain times of physical activity or emotional stress. The pain is the result of blocked arteries, which can prevent adequate blood and oxygen from getting to the heart muscle, causing pain.

To relieve the condition, doctors will open the blockages with stents, metal mesh tubes that can be plain or coated with medication to keep the artery open.

Some recent analyses have pointed to the benefit of stents in treating coronary artery disease, but the authors of the current analysis point out that that data came from the 1980s and 1990s, when patients were often treated with balloon angioplasty rather than stents, and when modern drug treatments, such as statins, beta blockers and ACE inhibitors were not yet available.

"Medical management of coronary artery disease with aggressive statin therapy and other medications is much better now than it was in the past," said Dr. Jon Resar, director of interventional cardiology at Johns Hopkins Hospital in Baltimore.

But the popularity of stents persists, despite mounting evidence that less invasive, cheaper drug treatments are just as effective.

The current report analyzed eight clinical trials and a total of 7,229 patients, half of whom received stents and half of whom received medical therapy alone. The treatment outcomes were virtually the same for both groups: 8.9 percent of patients with stents died, compared with 9.1 percent of patients on medication only; 8.9 percent of the stent patients had nonfatal heart attacks, compared with 8.1 percent of the medicated patients.

Nearly 31 percent of patients who took medication eventually got a stent, and more than 21 percent of patients with one stent had to get another stent.

The results of the analysis don't come as a surprise to many cardiologists, who say the knowledge that stents aren't effective in preventing death or heart attacks is widespread. Many treatment guidelines already recommend giving medications to patients with coronary artery disease before turning to stents.

What is surprising, experts say, is that so many physicians continue to recommend and implant stents to treat stable coronary artery disease without first trying to treat patients with medication.

Dr. David Fischman, co-director of the cardiac catheterization lab at Thomas Jefferson University in Philadelphia, said there was never any evidence that they reduce the risk of death or prevent heart attacks in patients with stable disease.

Some say the way the U.S. health care payment system encourages hospitals and doctors to perform revenue-generating procedures rather than prescribing medications. Procedures to insert stents can cost as much as $50,000. The authors of the current analysis estimate that avoiding stents by treating patients with medication only could save the health care system $9,450 per patient.

Resar said some cardiologists turned to stents in response to patients who want more aggressive solutions to their blocked arteries.

"Many patients just want a blockage fixed with a stent," Resar said. "Patients need to understand that simply putting in a stent in a blockage doesn't address the underlying problem. Lifestyle changes and aggressive medical management are far more important than just putting in a stent."

The analysis did note that stents were associated with a reduction in angina. Of patients who received stents, 29 percent still had persistent angina, versus 33 percent of patients treated with medical therapy alone.

Dr. Kirk Garratt, an interventional cardiologist at Lenox Hill Hospital in New York City, said those findings support the value of stents in improving the quality of life of patients who suffer from the disabling chest pain of angina.

"This means stents can help get more patients back to an active lifestyle, back to work and closer to a normal life," he said. "The anti-angioplasty league says this means stents have no value, but I find support for the way we care for our patients."

Copyright 2012 ABC News Radio


Selective Use of Drug-Eluting Stents Saving Millions of Health Care Dollars

Jupiterimages/Thinkstock(DALLAS) -- With medical costs soaring, researchers have found a way to control expenses for heart stents without cost to patients.

More than half a million heart stents are implanted every year in the U.S.  The procedure, a less invasive alternative to bypass surgery, consists of surgically inserting a tube into a narrowed artery to keep it open and keep blood flowing normally.  Some are coated with medicine to help prevent blood clots.

These drug-eluting stents are the subject of a new study in the journal Circulation, published by the American Heart Association. It followed more than 10,000 patients at 55 medical centers.
The authors found that limiting the use of drug-eluting stents to a selected group of patients is saving the U.S. heath care system more than $400 million a year.
And while the use of the stents decreased from 92 percent between 2004 and 2006 to 68 percent in 2007, rates of patient death and heart attack remained virtually unchanged.

By targeting the highest-risk patients, doctors were able to do many fewer stent procedures while preserving the clinical benefits.
Copyright 2011 ABC News Radio


Omega-3s Could Reduce Risk of Heart Attack in Stent Patients

Paul Tearle/Thinkstock(KRAKOW, Poland) -- When combined with blood-thinning drugs, omega-3 fatty acids could help to cut down the risk of heart attacks in patients with stents implanted in their coronary arteries, according to a new study from Poland.

A stent is a small tube placed in the coronary arteries of heart disease patients to allow for more normal blood and oxygen flow to the heart.  If blood clots form and create blockage at the stent, then the result could be heart attack.

Researchers in the study looked at 54 patients with an average age of 63 who had undergone the stent procedure.  During the weeks after the stent implantation, the patients were taking the standard daily therapy for their condition -- an anti-platelet drug (Plavix) and aspirin.  Twenty-four patients were then given a placebo pill and 30 received an omega-3 pill.  

Researchers found that those taking the omega-3 fatty acids experienced improvements, compared to the placebo group.

"Our results demonstrated improved clot properties and decreased thrombin [clot promoter] formation after treatment with the fish oil capsules," Dr. Grzegorz Gajos of John Paul II Hospital in Krakow, Poland stated in the research report.

The authors of the study noted that their findings may not be applicable to other groups, such as healthy people or those with high-risk coronary artery disease and those not taking blood thinners.

Copyright 2011 ABC News Radio


Heart Patients Recover Equally Well with Bypass Surgery, Stents 

Jupiterimages/Thinkstock(KANSAS CITY, Mo.) -- Findings from a new study suggest that whether one has heart bypass surgery or undergoes a less-invasive procedure in which medicated stents are used to open clogged arteries, cardiac patients may manage their recovery similarly.

"The degree of symptom relief is very comparable," said study author Dr. David Cohen, director of cardiovascular research at Saint Luke's Mid America Heart Institute in Kansas City, Mo. 

Patients can feel comfortable with whatever option they choose. However HealthDay News notes that the most severe cases fare better with bypass surgery, despite the quick recovery time of the stent procedure.

Dr. Kirk N. Garratt of the Lenox Hill Heart and Vascular Institute in New York City commented that most patients, about 90 percent, "do just fine" taking medication for arterial blockage, but surgery is necessary for other cardiac care patients.

Garratt said that with bypass surgery, the body may try to heal itself, thereby causing post-op scar tissue to form, which can be harmful.  This is one reason the stent procedure has become the preferable option -- the stents are coated with a drug that can help to prevent this scar tissue from forming.

The study, which followed up with 1,800 heart patients who underwent bypass surgery or the stent prodecure, showed that 76 percent of bypass patients had no chest pain within a year after the operation, while 72 percent of stent patients said the same.

While neither procedure can guarantee a longer life for heart patients, Garratt said both do improve quality of life.

Copyright 2011 ABC News Radio

ABC News Radio