Stents do prevent heart deaths

TO STENT or not to stent: that was the question being asked by many cardiologists after two major trials showed the benefits of the heart procedure were not clear-cut.

Stents are tiny wire tubes that are inserted into clogged heart arteries, which act as a scaffold, keeping them open and restoring circulation.

About 100,000 are implanted every year in the UK, in a simple operation where a fine, flexible wire known as a catheter is inserted via a tiny cut in the groin or wrist. This is threaded through blood vessels, ultimately placing the stent in the arteries supplying the heart.

Most stents are given after patients suffer a heart attack, to prevent a second one, and used like this they are a lifesaver, drastically improving health and preventing early death. However, patients are also commonly given them when they’re considered high risk but before they’ve had a heart attack.

A landmark trial published in 2019 raised doubts over this practice, suggesting that over three years the operation did not prevent any more heart attacks than drugs alone.

But last week a longer-term follow-up of that study came to a different conclusion. After six years, the researchers found stents prevented more heart attacks and other heart-related deaths than medication alone. There were 22 per cent fewer heart attacks in the stent group.

Confusingly, however, the number of people in both groups who died of all causes, including non-heart causes, was the same. London-based cardiologist Professor Divaka Perera says: ‘If you carry on a trial for long enough, everyone will die. Inserting a stent won’t prevent someone developing cancer or being in a road accident.

‘However, I tell my patients, if you have chest pain and other angina symptoms, a stent can make you feel better, and it will reduce the chances of you dying from a heart attack. For younger patients, particularly, this is an important finding.’