Stents Save Coronaries, Not Lives
Coronary stents do not improve the long-term survival rates of heart patients
but they "do provide a significant early and sustained reduction in the
need for subsequent procedures to re-open the treated artery," according to
a report presented by Duke cardiologist
David Kandzari at the American Heart Association meeting.
Comment: If stents "provide
a significant early and sustained reduction in the need for subsequent
procedures to re-open the treated artery," stents are doing a pretty good job.
The trouble, we would think, is that propping open a coronary artery with a
stent is like putting a finger in
the dike of atherosclerosis. What is needed is to halt or reverse the
atherosclerotic process entirely and that cannot be done by a small mechanical
device.
Barbara K. Hecht,
Ph.D.
Frederick Hecht, M.D.
Medical Editors, MedicineNet.com
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Coronary Stents Do Not Improve Long-Term Survival
DURHAM, N.C. -- While the placement of stents in newly
reopened coronary arteries has been shown to reduce the need for repeat angioplasty procedures, researchers
from the Duke Clinical Research Institute have found that stents have no impact
on mortality over the long term.
In the largest such analysis of
its kind, the Duke researchers said their findings have important economic and
clinical implications for physicians who are deciding whether their heart
patients should receive coronary artery bypass surgery, or less-invasive angioplasty, which includes the placement of a stent.
Stents, which were introduced in the U.S. in 1994, are
tiny mesh tubes that
are inserted at the site of a blockage in a coronary artery that has been opened
during balloon angioplasty. The procedure seeks to prevent the artery from
becoming blocked again, a process known as restenosis. These blockages, caused
by atherosclerotic plaque, can starve the heart of oxygen-rich blood and lead
to a heart attack.
Duke cardiologist David Kandzari, M.D., who presented the results of the Duke
analysis Nov.7, 2004, at the American Heart Association's annual scientific
sessions in New Orleans, said the findings on mortality rates should also be
expected to hold true for the latest generation of drug-eluting stents. These
stents, which were introduced in 2003, are coated with a drug that keeps blood
clots from forming inside them.
"We have found in our long-term analysis that stents do provide a
significant early and sustained reduction in the need for subsequent procedures
to re-open the treated artery," Kandzari said. "However, we also found
that stents do not have any influence on long-term survival.
"Since earlier studies have shown that new drug-eluting stents can
lessen the incidence of restenosis, we would expect the need for repeat
procedures to decline even more as these stents become more widely used,"
Kandzari continued. "While earlier trials of drug-eluting stents have
demonstrated a significant reduction in repeat procedures, they still have shown
no differences in mortality compared with more conventional stents."
Specifically, the researchers found that over the average seven-year
follow-up period of their study, 19 percent of patients who received a stent
needed another revascularization procedure in the treated artery, compared to 27
percent for those who did not receive a stent. However, the long-term mortality
rate for those receiving a stent was 19.9 percent vs. 20.4 percent for those who
did not, a disparity which did not statistically differ.
For their analysis, the researchers consulted the Duke
Database for Cardiovascular Disease, which keeps detailed clinical data on all heart patients
receiving treatment at Duke. The researchers identified 1,288 matched pairs of
patients who underwent either balloon angioplasty alone or stenting -- yet all
had a similar likelihood of receiving a stent based on their clinical and
demographic characteristics.
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