Overuse of stents in heart cases reported
MILWAUKEE - A new study gives fresh evidence that many people with clogged heart arteries are being overtreated with stents, and that a simple blood-flow test might help prevent unnecessary care.
Fewer deaths, heart attacks, and repeat procedures occurred when doctors implanted fewer of these tiny artery props, using the blood-flow test to decide when they were truly needed, the study found.
Results were published in today's New England Journal of Medicine.
Several reports in recent years have suggested that stents and artery-opening angioplasty procedures were being overused in non-emergency cases, often without giving medicine alone a chance to work. Concern about stent complications also has made doctors more cautious about elective angioplasty.
"It's really raised a lot of question about when is it appropriate," said Dr. Robert Harrington, director of the Duke Clinical Research Institute, who had no role in the new study.
The test has been around for some years but is used in only about 10 percent of angioplasties now, several heart specialists said.
The study was done in the United States and Europe, and involved 1,005 people who were having chest pain because of reduced blood flow to the heart or were recovering from a mild heart attack.
Half of the study participants had their narrowed areas treated with angioplasty and stents, as indicated by angiograms alone.
The rest were given a blood-flow test.
Results: people given the blood-flow test received on average, roughly two stents versus roughly three for the others.
A year later, only 13 percent of them had died, suffered a heart attack or needed further artery treatment, versus 18 percent of those treated on the basis of angiograms alone. Rates of chest pain at one year were similar.