Use of stents questioned for some heart patients

WASHINGTON – Propping open clogged arteries with a tiny wire mesh tube called a stent is no better at reducing the risk of heart attack or death in patients with stable heart disease than treatment with medications, according to a large new study that challenges routine use of a procedure that rapidly became standard medical practice.

The study of more than 2,000 patients found that those who had the expensive procedure, known as angioplasty, in nonemergency situations were no less likely to suffer a heart attack or die than those who only took aspirin and other medicines to thin their blood and lower blood pressure and cholesterol, along with adopting lifestyle changes.

The study, led by Dr. William Boden of the University of Buffalo, is the first large comparison of angioplasty to nonsurgical care for patients who are not actually having heart attack or in imminent danger of one.

Patients routinely undergo the procedure to relieve chest pain and to reduce the risk of having or dying from a heart attack.

“These findings are pretty explosive,” said Steven Nissen, president of the American College of Cardiology. “I think this is going to shake things up pretty significantly.”

The researchers and others stressed that angioplasty clearly benefits patients who are in the throes of a heart attack or are at very high risk for one.

But the findings indicate that for a patient whose condition is stable, medical therapy is just as effective at reducing the major risks. Such patients constitute at least one-third of those undergoing the 1.2 million angioplasties performed each year, and perhaps as much as 85 percent.

Study results were published online by the New England Journal of Medicine and will be in the April 12 issue.

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