Stents don’t work.

Stents don’t work.

That was the conclusion of a study that recently rocked the cardiology community.

Stents have been used to open blocked heart arteries for decades.  The first one was implanted in 1986 and use of stents quickly became commonplace.  That’s because the little mesh devices, when expanded within arteries, are really good at keeping those arteries open.  Inserting a stent costs between $11,000 and $41,000, and it’s estimated that at least 500,000 people undergo the procedure each year.

There is no question that stents can be lifesaving when they’re part of the treatment protocol for a heart attack.  But most stents are not put in during heart attacks.  Most stents are implanted because a blockage has been discovered after someone has been evaluated for angina (chest pain that occurs with exertion).

At first, everyone – patients and doctors alike – were convinced that inserting stents in people with angina prevented future heart attacks.  Turns out that’s not the case.  A large study, called the COURAGE trial, published 10 years ago, found that there was no difference in the rates of subsequent heart attack, death or stroke between patients treated with stents as compared to those treated with medications alone.

But stents kept getting implanted. Because everyone – patients and doctors alike – were convinced that stents were really good at eliminating angina.  Turns out that’s not the case either.

A new study – the one that rocked the cardiology universe – found NO DIFFERENCE in chest pain relief among patients treated with stents compared to those undergoing a sham procedure. 

The study was done in England and all patients were given drugs to reduce the risk of heart attack and prevent blood clots.  Neither the patients nor the clinicians observing them during 6 weeks of post-procedure follow-up knew who got a stent and who didn’t. 

And here’s the huge surprise finding – after 6 weeks, patients reported improvement in angina symptoms and demonstrated improved stress test results, regardless of whether they received a stent or not.

The chance that this one study will change practice patterns is low.  Already, questions are arising as to whether 6 weeks of follow-up is enough.  But the findings should truly give us pause as to how we treat heart disease today.  Because pre-conceived notions about the effectiveness of our standard therapies just might be completely wrong.

What isn’t in dispute?

  1. A stent can save your life if you’re in the throes of a heart attack.
  2. Lifestyle change – and especially a better diet - can reverse blockages, improve blood flow and help you avoid that heart attack in the first place. 

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