Are stents worth it?
The study into the use of stents has just been published in the medical journal The Lancet. It questions whether stents should be used so often, or indeed at all, in treating some forms of chest pain.
Bupa Australia’s Chief Medical Officer Dr Paul Bates says people should look at what sort of heart issues they have before jumping to any conclusions.
“If your pattern of chest pain is worsening or unstable, then you probably need to have a stent - that's the standard of care. But if you have stable angina or you don't have symptoms, then it is very important to ask your doctor what the benefits of the stent would be over just straight pills.”
A coronary stent holds the coronary artery open to improve blood flow to the heart.
It’s inserted when a balloon-tipped catheter is passed through a sheath and into the coronary artery at the site of the narrowing or blockage.
The catheter is then inflated, compressing the narrowing or blockage, and opening the artery.
Stents still the standard of care
Dr Bates says it’s important to have an informed conversation with your doctor if stent surgery is proposed.
“There is no doubt that stents are effective for people who are suffering a heart attack or who have what's called an unstable angina which is a pre-heart attack circumstance.”
“However, the study adds weight to questioning the value of stents for people who have stable angina.”
“The other thing that is not fully appreciated is that when you have a stent and you have stable heart disease, it doesn't improve your outcomes, it helps you get better control of symptoms,” said Dr Bates.
Stent study the first of its kind
The Lancet findings come from the ORBITA trial; a blinded, randomised, placebo-controlled study of 200 patients with stable angina.
For the first time, researchers compared using stents to widen arteries with a simulated procedure - where a stent was not implanted.
The results showed patients with stents had no significant additional benefit on symptoms or quality of life compared to those patients without stents.
"Surprisingly, even though the stents improved blood supply, they didn't provide more relief of symptoms compared to drug treatments, at least in this patient group," said Dr Rasha Al-Lamee, the lead author of the study from the National Heart & Lung Institute at Imperial College London.
The cost of stents
Inserting a stent can cost up to $10,000, including the cost of the devices, doctors and hospital fees.
In 2015-16 there were 18,000 stenting procedures performed in New South Wales alone.
This new study does raise questions of the widespread use of stents.
“If you have a heart attack or you are in a pre-heart attack situation- most people need a stent. But for people with stable angina, there is a question about the benefits of having a stent,” says Bupa’s Dr Paul Bates.
A placebo effect?
"The most important reason we give patients a stent is to unblock an artery when they are having a heart attack,” said the study’s leader Dr Al-Lamee.
“However, we also place stents into patients who are getting pain only on exertion caused by narrowed, but not blocked arteries. It's this second group that we studied."
"While these findings are interesting and deserve more attention, they do not mean that patients should never undergo the procedure for stable angina.
“It may be that some patients opt to have an invasive procedure over taking long-term medication to control their symptoms," she added.
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