Coronary Artery Stents are Not Effective

For some time now, a popular method for treating stable coronary artery disease (a coronary artery narrowed by atherosclerotic plaque) has been to implant a stent in the affected area. A stent is an expandable metal mesh tube on the tip of a long catheter. The stent is inserted into an artery in an arm or leg and then threaded up into the coronary artery to the point of narrowing. Once in place, the stent is expanded to widen the coronary artery. The catheter is then withdrawn, leaving the stent in place.

Stents are sometimes preferred over coronary artery bypass graft (CABG) surgery because stents do not require open-chest surgery. In addition, the symptoms of stable coronary artery disease (such as a type of heart pain called angina) tend to go away right after surgery. Typically the patient is back on his/her feet within a day or two. Surgeons and hospitals like stents, too, because at $30,000 - $50,000 per patient, they are big money makers.

Unfortunately, a recent review of over 7,000 patients enrolled in eight different clinical trials showed that stents have little or no advantage over standard medical care with drugs. About half of the patients in the studies were given stents plus standard medical care (treatment with beta-blockers, statins, aspirin, or ACE inhibitors). The other half of the patients received just the standard medical care. Four years later, there were no differences in patient outcomes between the two groups in terms of reduced angina, fewer heart attacks, or death.

Will this new information affect the number of stents implanted every year? Time will tell. But in the interest of informed consent, I hope that the information will be at least given to patients before they choose to have a stent implanted.