The placebo effect of stents in cardiac patients
That may indicate that medication therapy alone, instead of the expensive, artery-opening apparatus, is all that is required for specific patients, the investigators stated.
“The main reason we provide patients a stent would be to unblock an artery when they’re having a heart attack. But, we also put stents into patients that are getting pain just on exertion due to narrowed, but not obstructed, arteries. It is this second group that we studied,” explained lead author Rasha Al-Lamee, by the National Heart and Lung Institute at Imperial College London.
The analysis included 200 patients with stable angina who received six months of intensive drug therapy due to their angina. Following that, they either obtained a stent or failed a simulated process at which no stent has been implanted.
Patients who received stents didn’t have additional developments in angina or high quality of life compared to those who didn’t receive a stent. Angina is the medical term for chest discomfort. It’s normally brought on by the build-up of fatty plaques in the arteries.
Stents are not inexpensive, either: The apparatus as well as their prices them prices from $11,000 to $41,000 at hospitals in america.
The study was published online Nov. 2 in The Lancet medical journal, to coincide with a demonstration at a cardiology meeting in Denver.
“Astonishingly, even though the stents increased blood supply, they did not provide additional relief of symptoms in contrast to medication remedies, at least in this patient category,” Al-Lamee stated in a university news release.
“While these findings are intriguing and deserve more care, they don’t indicate that patients shouldn’t experience the [stent] process of stable angina. It might be that some patients choose to have an invasive process over taking long-term drugs to control their symptoms,” she added.
The researchers plan further investigation of the information, to decide whether there are subgroups of patients whose angina enhances more after stenting.
“It appears that the connection between opening a narrowing coronary artery and enhancing symptoms isn’t quite as straightforward as everyone had expected,” Al-Lamee explained. “Here is the first trial of its type, and [it] helps us to develop a better comprehension of stable angina, a disorder which affects so a number of our patients daily.”
Composing in a commentary that accompanied the report, two cardiologists stated the “landmark” research has consequences that “are deep and far-reaching.”
“First and foremost, the consequences of [the research] show unequivocally that there aren’t any advantages” for using stents in comparison to drug treatment for those that have stable angina, stated Dr. David Brown, of Washington University School of Medicine in St. Louis, along with Dr. Rita Redberg, at the University of California, San Francisco.
In actuality, depending on the newest findings, Brown and Redberg consider that stents might not be helpful in such instances even when a patient’s angina fails to secure better following drugs are utilized.
“Based on these information, all of cardiology guidelines must be revised to downgrade the recommendation to get [stents] in patients with angina,” whether or not they also obtained medication treatment, the physicians said.
Based on Brown and Redberg, annually over a half-million patients in the USA and Europe experience stent therapy — and also a sizeable minority may encounter potentially dangerous complications which may include heart attack, kidney injury, stroke and even death. Subjecting those patients to those dangers when no advantage can be attained is reckless, they stated.
Doctors will need to concentrate more on medication therapy and attempts in “enhancing the lifestyle options” of numerous heart problems — things such as poor diets, lack of exercise and smoking, the editorialists reasoned.