Angioplasty not always necessary
DEAR DOCTOR: I’ve been having chest pain, and my doctor said that although I shouldn’t panic, I should consider a stent. Now I read they’re useless.
DEAR READER: What you’re describing is angina: chest pain caused by decreased blood flow to the heart via the coronary arteries. Stable angina occurs with exertion, not rest, because the exertion makes your heart work harder. Unstable angina is irregular, can occur even at rest and is a harbinger of an imminent heart attack.
In 1977, doctors began to treat angina with angioplasty, which uses a balloon to open the partially clogged coronary arteries. In the 1990s, they started using stents to keep the arteries open and make them less likely to collapse. Angioplasty has been found to reduce the risk of heart attacks and strokes in people with unstable angina.
For stable angina, the picture recently became murkier. The study to which you’re referring assessed outcomes in stable angina patients with one or more coronary arteries at least 70 percent narrowed. In the first six weeks of the study, participants received standard medical therapy, including blood thinners, cholesterol-lowering medication, blood pressure medications and long-acting nitrates.
After that, study subjects were randomized into a group that received a stent or a control group that didn’t receive a stent. After another six weeks, all the patients underwent a cardiac stress test and an assessment of symptoms. No difference in symptoms was found.
That said, stents are not useless. They do prevent heart attacks and death in people with unstable angina, and they may benefit people with stable angina who have symptoms even on medication or who are intolerant to medication.