Drugs As Good As Stents For Angina Pain
Someone suffering from the frightening chest pain of angina is no doubt ready for a quick fix to make that pain go away. Many angina patients turn to stents for the quickest relief, opting out of drug therapy, which takes a little longer to take effect. New information made available in today’s New England Journal of Medicine says, in the long run, the pain-relieving effects of stenting, or angioplasty, disappears in two or three years’ time, eventually bringing no more relief than a steady course of drug therapy would have.
The stent, of course, comes with the all the risks of invasive surgery involved and with a price tag in excess of $44,000. In light of the long-term benefits of both therapeutic strategies, William Weintraub, professor of medicine at Philadelphia’s Thomas Jefferson University, says drug therapy alone is a safe approach. His work as lead author of the study concludes stenting is probably overdone in the United States and Canada, accounting for hundreds of thousands of elective angioplasties that were most likely unnecessary. Weintraub also serves as head of cardiology at the Christiana Care Health System, Newark, Delaware.
In a separate study, researchers at Aurora St. Luke’s Medical Center in Milwaukee, Wisconsin, also concluded that angioplasty is overdone and probably brings little actual relief to as many as 50,000 patients getting angioplasties days after having a heart attack. The Milwaukee study did confirm the benefits of undergoing angioplasty within 24 hours of a heart attack, however, a window of opportunity in which the procedure can be a life-saving decision.
Robert Ninneman, chief of cardiology at the Milwaukee medical center, compared heart attack patients getting angioplasty plus standard drug therapies against similar patients getting the standard drug treatment only. Within three months, each group reported about as much pain relief as the other group did.
Ninneman suggests the high number of angioplasties performed each year could be attributed to the speed with which family practitioners and other physicians refer heart patients to cardiology specialists, who are trained to bring the quickest relief possible. An entirely separate area of specialization is interventional cardiology, in which angioplasties and stent placement are their focus. The study suggests the medical profession’s willingness to condone angioplasties may be in need of further discussion.
Source: Milwaukee Journal Sentinel
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As a former interventional cardiologist, I can confirm the so-called oculo-stenotic reflex (the interventionalists tendency to stent narrowings without necessarily engaging their brains) is a real problem.
Patients commonly believe that it is safer to have angioplasty than leave the narrowings alone but this is only true in the first hours following a heart attack. The recent COURAGE trial confirms the earlier RITA 2 study which showed angioplasty doesn’t prevent heart attacks. In other words it is safe to defer angioplasty until sensible conservative treatments have been tried. Unfortunately, patients don’t know this and feel pressurised into accepting angioplasty.
In my practice, the majority of patients who learn the facts about how poor angioplasty is at producing a long lasting improvement, choose not to have the procedure.