A review of eight studies, including 7,229 patients, found that implanting stents, tubes used to prop open a blocked artery, in patients with stable coronary artery disease was no more effective than using medications.
Researchers from Stony Brook University Medical Center combined and analyzed data from randomized controlled trials conducted between 1997 and 2005 that compared stenting with medical therapy and followed patients over an average of about four years.
While the analysis found slight differences between the groups in deaths, nonfatal heart attacks, persistent chest pain, and further surgical interventions, none was statistically significant.
The authors note that their results are different than those of two recent analyses, which found fewer deaths and reduced chest pain in patients who had stenting. They suggest that many of the 400,000 procedures performed each year in the United States to treat the stable form of the disease may not be necessary.
BOTTOM LINE: A review of clinical trials found that stenting was no more effective in the treatment of stable coronary artery disease than use of appropriate medications.
CAUTIONS: The authors note that the study did not account for all possible benefits or harms posed by the two treatment options. The study results were not analyzed by age or sex.
WHERE TO FIND IT: Archives of Internal Medicine, Feb. 27
Medicare patients mostly not told of stent alternatives
Few Medicare patients surveyed after they had an elective procedure to implant a stent said their doctors discussed alternatives that may be as effective and have fewer risks, such as managing coronary artery disease with medication and lifestyle changes.
Researchers from the Informed Medical Decisions Foundation in Boston and the Dartmouth Institute, in collaboration with the Centers for Medicare & Medicaid Services, surveyed people who had an elective procedure in 2008. Those who had a stent implanted soon after a heart attack or following a visit to the emergency department were excluded.
Among 472 respondents, 10 percent said doctors had presented them with serious alternatives to stenting. While more than three-quarters said they discussed the reasons for the stenting “a lot’’ or “some’’ with their physicians, 19 percent reported similar levels of discussion about reasons they may not want to have the procedure. Sixteen percent said they were asked about their own treatment preference.
Floyd J. Fowler Jr., a senior scientific adviser at the Boston foundation, said stent procedures often are done in conjunction with angiograms, used to analyze arterial blood flow. He said patients should be given information about stents and alternatives beforehand.
BOTTOM LINE: Few Medicare patients who had a coronary artery stent implanted said doctors spent time discussing alternatives.
CAUTIONS: Patient responses to surveys can be inaccurate. The study included only those people who had the procedure.
WHERE TO FIND IT: Journal of General Internal Medicine, online Feb. 28