Late Treatment with Stents QuestionedFeb 19, 2009 | Parker Waichman LLP
Cardiac stents have been the subject of much controversy in recent months and, now, two emerging studies have found that patients do not fare better over medications and other treatments than with stents following heart attacks.
Stents are tiny wire-mesh tubes used to prop open arteries after doctors clear them of blockages. Some stents have a drug coating meant to keep vessels from re-clogging following such procedures.
Reuters said that the studies found that stents, when used following an untreated heart attack, offer no better treatment than other protocols. One study found, said Reuters, that one in three heart attack cases do not receive immediate stent treatment following a heart attack because, for instance, patients might not seek treatment in the immediate hours or days following the crisis. By the time patients seek help, the heart muscle is already likely damaged, points out Reuters.
"Our study specifically addresses the question of whether, with a complete blockage, there is any benefit, now that the dust has settled after the acute heart attack, to opening the artery anyhow," said Dr. Daniel Mark of the Duke University Medical Center in North Carolina, quoted Reuters. Dr. Mark led the international study. "I think our comprehensive answer to that is the benefit is very small and it's not worth the extra cost of doing the procedure," he added.
Bloomberg News said that medications and heart bypass offered greater protection over angioplasty and stents—both of which open arteries. Initial findings from the Occluded Artery Trial (OAT) revealed that four years following heart attacks, the death rate, incidence of heart failure, or a follow-up heart attack were not minimized by a so-called “late attempt” at removing heart blockage, said Reuters. Dr. Mark told Reuters that “the heart muscle where that artery is blocked is pretty much dead, and it's not going to help it out by opening the artery."
The findings also indicated that one year following stent implantation, patients were as unable to climb stairs as those not implanted, said Reuters. Also, while 477 stent patients received hospital bills about $7,000 higher than nonstent patients, their quality of life was shorter—after two years—than those patients treated with medications only.
Authors of the “Syntax” study led by Patrick Serruys, a cardiologist at Rotterdam’s Erasmus University, said that heart bypass should remain “the standard of care” though its advantages must be balanced against stroke risk, which can occur following bypass, and longer surgery recuperation times over stent implantation, reported Reuters.
Bloomberg noted that both studies were published online, today, in the New England Journal of Medicine, adding that, in the U.S. doctors performed no less than 800,000 angioplasties last year for a total cost of $10 billion. Of these, Duke University concluded that about half could have received comparable treatment via drugs, diet, and exercise, with less risk of re-clogging. The researchers said that the results of both studies “adds only a modest early advantage with regard to symptoms and functional status, and this advantage is not maintained,” reported Bloomberg.