NEJM studies shed light on stents

Two observational studies about stents in tomorrow’s New England Journal of Medicine offer important information about using the devices to keep blood vessels to the heart clear, a Harvard doctor writes in an accompanying editorial.

One study looked at New York State patients who had blockages in multiple heart arteries. It compared those who underwent coronary artery bypass surgery with patients who received drug-eluting stents, small metal mesh tubes coated with a drug to reduce renarrowing of the arteries into which they are inserted. The researchers found that patients who had surgery needed fewer repeat procedures, had fewer heart attacks, and had a lower death rate compared with patients who were given stents.

The other study looked at patients from a large national registry who received bare-metal and medicated stents for conditions considered “off-label,” or not meeting the conditions for which the devices were approved by the FDA. There was no difference in death rates between the two kinds of stents, the authors found.

“The New York State registries affirm that CABG (coronary artery bypass graft surgery) remains the standard of care for patients who require multivessel coronary revascularization. However, stents may be an alternative for patients at high risk for surgical complications or when an informed patient chooses a less invasive option,” Dr. Joseph P. Carrozza of Harvard Medical School and Beth Israel Deaconess Medical Center writes. “Additional studies are needed before the findings for off-label use … can be considered the final word. Although we confront clinical decisions in the absence of the totality of data, these two studies go a long way toward making these decisions more evidence based.”