Coronary Artery Stents Don't Reduce Angina Pain

For decades, cardiologists have been inserting stents into their patients' partially blocked coronary arteries in order to improve blood flow to the heart. Stents are particularly effective in patients who have already suffered a heart attack. But stents are also used to improve coronary blood flow in patients who have not had a heart attack but are suffering from angina, the chest pain that some patients feel when coronary blood flow is compromised. It makes sense, right? It's always a good idea to improve coronary blood flow.....isn't it?

Cardiologists generally think so. And it's a big business for them; more than 500,000 stents are performed every year at $14,000 - $40,000 a pop, according to some estimates. But now a new study by British researchers questions whether the patients are actually improved by the procedure.

The study is unusual in that it is a true double-blind study with a control group. Two hundred patients suffering from angina due to a severely blocked coronary artery were recruited. Half of them got a stent, and the other half underwent the same surgical procedure, but the stent was just inserted and then removed. It's hard to get approval for this kind of study in humans, because if you can show that a treatment works, you can't ethically withhold it from some patients just to prove a point! In fact, the stents did improve coronary blood flow in the patients that received them. But more to the point, there were no differences between the two groups in the ability to do exercise six weeks later or in their self-reported pain.

Cardiologists are busy assessing what it all means, according to an article in The New York Times. In all likelihood the clinical guidelines for the use of stents in patients with angina will have to be revised, or at least re-examined. And additional studies will probably be needed to try to determine whether there might be some other benefit of the stents, such as a reduced risk of heart attacks further down the road.