The People's Perspective on Medicine

Stents Ease Angina but Fail to Stretch Survival

PCI techniques to place stents can reduce pain from angina but don't help people with stable heart disease live longer than those being treated with drugs.

Angioplasty to place a stent or several stents in coronary arteries is known medically as percutaneous coronary intervention, or PCI.

This procedure is used to open blocked coronary arteries and treat chest pain due to angina. Doctors did not know for sure whether or not it would help people live longer.

PCI No Better Than Medication:

Now long-term results show no difference in survival between people randomly assigned to get drug treatment or PCI for their angina. The study included more than 2,000 people with stable heart disease who were followed up for as long as 15 years.

There were 284 deaths in the group that got PCI and 277 in the group getting medical therapy. That is not a statistically significant difference.

Treat Angina with Drugs:

The researchers point out that these results are consistent with those from several previous trials. Until data show an advantage to angioplasty and stents for angina, it may make more sense to treat this heart condition with medication.

New England Journal of Medicine, Nov. 12, 2015

It is important to point out that stents are sometimes placed when a person is in the midst of a heart attack. That situation is quite different, and these results do not apply to it.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I was reading about an alternative treatment for angina pain on web md. It’s call EEECP. It’s non-invasive and can be done in doctor’s office. Have you explored that?

The study sample number, angina definition and criteria are the only problem. I am interventional Cardiologist and if I have angina and if I have real stenosis of my coronary artery I would like stent. If I have no symptoms and if there is only plaque not real blockade I do not need any intervention but only life style moderation and pharmacology.

I witness day by day how stents are significantly stretching survival and quality of life to people and there are numerous scientific studies and trials to confirm that. But only to the people who need stents. Actually we should not intervene if there is no need in reality, because we can harm or do not improve something that does not need to be improved.

If my patient have angina that limits their life activity, than this limits his life expectancy as well. In this situation the coronary angio is indicated and if I find significant stenosis that needs treatment I will not hesitate to put stent in together with right pharmacology. COURAGE concludes that stents are not stretching survival. Only misguided trials with wrong definitions, who need and who do not need interventions, can conclude such travesty. Otherwise how can I help as doctor to patients complains? Just wait and pray. NO.

For example if you have today an golden ring and you do not need it today, it would be stupid to put it to wrong hand or to throw it away, you should use it when and where you are certain that you need the ring. You may walk around and talk that putting the ring is just not good job, but eventually you can end the day by doing just the thing that you have been talk against so loud.

I have a stent, had it placed in 1998 and, goodbye angina. There was a large blood clot in my largest artery; the others are unusually small, and even walking was enough to set off angina. No other sign of heart disease. I am glad I opted for the surgery vs years of medications with side effects. Still no sign of heart disease; however, I take a slew of supplements, including arginine.

You failed to mention who did the study, some thing you usually do. Studies are often supported by drug companies that earn ongoing money for every med we take, whereas the stent maker and cardiologist make money only once.

You also failed to mention side effects of the meds, something you usually do.

What happened to you this morning?

David

This large study (COURAGE) was funded by Veterans Affairs and the Canadian Institutes of Health Research. A bunch of companies made research grants to the VA: Merck, Pfizer, Bristol-Myers Squibb, Fujisawa, Kos Pharmaceuticals, Datascope, AstraZeneca, Key Pharmaceutical, Sanofi-Aventis, First Horizon, and GE Healthcare. The authors did not discuss the specific drug side effects. Here’s a link to the publication: http://www.nejm.org/doi/full/10.1056/NEJMoa1505532

I’m not a physician or health care professional of any sort but I did have a stent placed in one of my coronary arteries in 2012. I did not have a heart attack but knew something was wrong because of the aching in my arms when I had barely gotten into workouts that had been routine before. It is hard for me to imagine that I could have recovered any quicker or more completely if treated with medicine. Whether the stent extends my life or not is not as important to me as functioning and feeling well for as long as possible. My sense is that introducing more drugs into my body is not the way to go. I am on a statin and blood pressure drug but am really not sure I need them. There is something about the use of statistics like this to develop rigid protocols that bothers me. It may be expedient and sometimes necessary but every situation is different.

Over the past year I noticed a significant decline in my endurance. I thought I was just getting older and out of shape. I had been riding the stationary bike real hard for an hour. My pulse would reach 170+. Then all of a sudden I became spent after 5 or 10 minutes. My chest was tight but not painful. Thought I had a chest virus which would pass but it persisted. Had all the tests with negative results.
Finally had an angiogram. My doctor pointed at the screen, told me my LLD was over 90% blocked and I was only days away from a heart attack. He immediately called in a surgeon and I was given a medicated stent (actually 3 end to end). My procedure was two months ago and I am now back to the gym. I have no heart damage and feel better than I have for years. If I hadn’t been given a stent, I would probably be dead. To suggest my condition could have been treated only with meds and lifestyle is irresponsible.

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