PHILADELPHIA—Stents and coronary artery bypass surgery are no more effective than intensive drug treatment and better health habits in preventing millions of Americans from heart attacks and death, a large study found, shedding new light on a major controversy in cardiology. Researchers and doctors have fiercely debated for years how best to treat people who have narrowed coronary arteries but aren’t suffering acute symptoms.
The standard treatment has been to implant stents—wire mesh tubes that open up clogged arteries—or to perform bypass surgery, redirecting blood around a blockage. Those procedures are performed even though these patients either have no symptoms or feel chest pain only when they climb a few flights of stairs or exert themselves in some other way.
The study is the largest and among the most rigorous research yet to suggest that while stents and bypass surgery can be lifesaving for people who are having heart attacks, they aren’t necessarily better than cholesterol-lowering drugs and other changes in health habits for most people with chronic, or stable, coronary artery disease, which affects about 9.4 million Americans. But stents or bypass surgery work better than medicine and lifestyle changes alone in relieving symptoms for people who have frequent angina, or chest pain, the researchers found.
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At issue is how best to prevent heart attacks or other events. Cardiologists implant stents or perform a bypass to remove blockages in coronary arteries that reduce blood flow to the heart. Yet these large blockages, while frightening, don’t generally cause heart attacks, some research shows. They are caused instead more by ruptures in smaller, softer pieces of plaque that aren’t always visible on a scan. Medicines have improved over the past several years and shrink those dangerous small plaques, said Steven Nissen, chief academic officer of the Heart and Vascular Institute at the Cleveland Clinic. “The reason medical therapy is triumphing is that it’s treating the entire artery,” he said. “This is a systemic disease, not a local disease.” The results show “there is no compelling benefit to proceeding with these invasive procedures in people with stable symptoms as opposed to people with a heart attack,” he said.
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https://www.wsj.com/articles/study-finds-limited-benefits-of-stent-use-for-millions-with-heart-disease-11573931727 (paid subscription)
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