Stents not effective in chest pain

Stents not effective in chest pain

Stents are widely used internationally for stable chest pain considered first-line treatment-but the devices may not be helping. The Lancet published recently has sparked a heated international debate among doctors about how best to treat such patients-by inserting a mesh tube into their blocked artery to improve blood flow or by prescribing anti-angina pills? It shocked the international cardiology community as it reported that for patients with medically treated angina and severe coronary stenosis, an intervention did not have a more lasting effect than the effect of a placebo procedure.

 

Methodology:

 

 The study was conducted on 230 heart patients in the United Kingdom.

 

 Of the 230 participants with stable angina, 195 were randomly assigned procedures.

 

 Of those, 105 were given stents and 95, the control group, were given placebo procedures, where a catheter was inserted and then removed without placing a stent.

 

 The study was double blinded, which meant neither the participants nor the doctors who subsequently followed them for six weeks knew who had what procedure.

 

 

Key findings:

 

 The findings from the study contradicted the widespread assumption that using stents -a metal mesh tube to prop open clogged arteries - would allow patients to walk longer on a treadmill by hastening blood flow to the muscles that make the heart pump. Stent did not show any more improvement than people who only took medicine to improve their condition.

 

 Serious adverse events encountered during the study included four pressure-wire related complications in the placebo group, which required PCI, and five major bleeding events, including two in the PCI group and three in the placebo group.

 

Limitations of the study:

 

The findings have rocked the heart health world. However, questions already are being raised about how applicable the results will be for the world at large. Some area cardiologists say a landmark study released last week won’t change the way they practice, but it will help them to inform some patients about the need for a stent.

 

 The study involved a very select group of chest pain patients. They didn't include anybody who had more than one vessel seriously narrowed.

 

 The greatest concern is the six-week follow-up period, which many considered too short. The true impact clinically of this trial requires more than a six-week follow-up.

 

 Longer follow-up trials will be needed to see whether a purely drug-based approach is better in the long run for patients with stable angina.