Ongoing Debate: Do Heart Drugs Work as Well as Stents
Many heart patients who routinely receive stents to open arteries after angio-plasty might not be gaining any more permanent benefit than patients treated with drugs alone, according to a new controversial study. The researchers say that stents might be little better than the aggressive use of heart medications to prevent heart attacks and death and that stents are being used too often to treat stable, asymptomatic disease.
During a five-year clinical trial, called Clinical Outcomes Utilizing Revascular-ization and Aggressive Drug Evaluation (COURAGE), patients receiving stents in addition to using statins or other heart drugs had better blood flow to the heart than those using only drugs, but they did not live longer or have fewer heart attacks. It was concluded that angioplasty did not save lives or prevent heart attacks in non-emergency patients, and offered only slight or temporary relief from chest pain.
The trial enrolled patients from 1999 to 2004. More than 2,200 patients in the trial came largely from Veterans Administration hospitals in the U.S.
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The older bare metal stents were usually used (drug-coated stents were approved in 2003). Almost 95% of patients took aspirin, 90% took statins, 85% took beta blockers, and two thirds took angio-tensin-converting enzyme (ACE)-inhib-itors. The drug therapy patients were also more likely to have taken calcium-channel blockers and nitrates for angina.
Stents were developed to combat the tendency of the vessels to close after angioplasty. Drug-coated stents help preserve the channel created by angioplasty.
The results raise new questions about the value of angioplasty and stenting, widely used since the mid-1990s. Each year, almost one million Americans get stents after angioplasty. Patients with drug-coated stents must usually take anti-clotting drugs indefinitely. Bare metal stents carry less late clotting risk but tend to lead to arterial reclogging.
Since 2002, American Heart Association and the American College of Cardiology guidelines have called for angio-plasty and stenting (or bypass surgery) only after efforts have been made to treat symptoms with drugs, but patients and doctors have been choosing stenting, which provides relief sooner. hyzaar online
Attendees at the meeting said the new data should encourage more health care providers to follow the practice guidelines and to recommend drug therapy and healthier living to reduce the risk of heart attacks.
