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“The ISCHEMIA trial shows that an early invasive approach does not
protect patients against death or the overall chance of a heart attack,
but does effectively relieve chest pain — the more chest pain a patient
has, the more likely they are to benefit,” Antman said.
A major study more than a decade ago found stents didn’t work better
than drugs, but it triggered criticism, and proper use of stents has
become one of the most heated debates in medicine — in part because
so much is at stake. Coronary heart disease affects 17.6 million
Americans; companies that make stents are multibillion-dollar
enterprises; the procedures are a major income stream to interventional
cardiologists and hospitals; and many people who have stents credit
their good health to the procedure.
Stents and bypass surgery are no more effective than drugs for stable heart disease, highly anticipated trial results show “ Washington Post”
About 500,000 heart stent procedures are performed each year in the
United States, and the researchers estimate that about a fifth of those
are for people with stable heart disease. Of those, about a quarter — or
an estimated 23,000 procedures — are for people without any chest
pain. If just those procedures are avoided, researchers estimated, it
could save about $570 million each year. But the researchers think that
is a conservative estimate, and that as doctors and patients discuss
options, even more procedures might be delayed or skipped depending
on each patient’s circumstances, preferences and activity level.
Stents and bypass surgery are no more effective than drugs for stable heart disease, highly anticipated trial results show “ Washington Post”
The debate over the trial’s results began before it even finished.
More than a year ago, there were fierce social media
debates and critiques in the pages of medical journals. Critics
compared a change to the trial’s design to moving the goal posts
midway through and worried that it would make the results of the
trial hard to interpret. The leaders of the trial fired back that the
change was part of the original trial design.
Stents and bypass surgery are no more effective than drugs for stable heart disease, highly anticipated trial results show “ Washington Post”
More than 5,000 patients with moderate to severe stable heart disease from
320 sites in 37 countries were randomly assigned after a stress test indicated
heart disease. They received either medical therapy and lifestyle counseling
alone, or medicine plus stents or bypass surgery. There was a slight shift in the
two groups’ experience of a composite of five disease-related events over the
course of the trial: In the first year, people who received an invasive strategy
were at slightly higher risk of heart attacks than those on medicine alone. By
the end of the trial at four years, they were at a slightly lower risk of heart
attacks. The researchers found that this did not lead to a significant difference
between the overall rates of clinical events between the two groups, but
Garratt pointed to this decreased risk as an important and significant result.
Stents and bypass surgery are no more effective than drugs for stable heart disease, highly anticipated trial results show “ Washington Post”
The new study, Antman said, will give patients and doctors a solid
framework to discuss the benefits and risks. For example, an
elderly patient with stable heart disease who isn’t very active but
suffers some chest pain may decide on drug therapy. A younger
patient who has more frequent chest pain that impedes active
daily life could opt for an invasive strategy.
Stents and bypass surgery are no more effective than drugs for stable heart disease, highly anticipated trial results show “ Washington Post”