Heart Stents are not always Beneficial for treating Stable Angina (Chest Pain)

New findings in the field of cardiovascular research can transform patient care, a latest study proposes that the placebo effect of stents in heart disease patients with chest pain may be far more pronounced than thought.
That could mean that drug treatment alone, rather than the expensive, artery-opening cardiac stents, is all that’s required for most of the patients, the researchers said.
“The primary reason for considering a stent placement is to unblock the culprit artery that is causing a life-threatening heart attack. However, stents are also placed into patients who complain of chest pain on physical exertion caused by narrowed arteries of the heart. It’s the second group of patients that we studied,” explained lead author Rasha Al-Lamee, from National Heart and Lung Institute and Imperial College London.”
The researchers recruited 200 patients with stable angina who underwent six weeks of intense drug treatment for their angina. After that, they either received a stent or underwent a simulated procedure where no stent was inserted. The subjects who received stents did not show improvements in chest pain and quality of life compared to those who did not receive a stent.
Angina is the medical term for chest pain. It is typically caused by the build-up of fatty plaques in the coronary vessels. Stents aren’t cheap, either: The stent and its insertion costs from $11,000 to $41,000.
The study was published on the world wide web in The Lancet medical journal, to coincide with a presentation at a cardiology meet in Denver. Al -Lamee stated in a press release that “Surprisingly, even though the stents helped in increasing the blood supply to the affected part of the heart, however, they did not provide any relief of symptoms compared to previous drug treatments, at least in this patient group,”.
“While these conclusions are compelling and deserve more consideration. however, they do not suggest that patients should never undergo the [stent] placement for stable chest pain. There are several patients who opt to have an invasive procedure overtaking long-term medication to control the symptoms of chest pain,” she added.
The physicians plan to analyze their data further, to determine if there is a group of subjects whose chest pain improves after stenting.
“It seems that the connection between opening a blocked coronary artery and improving symptoms is not as simple as everyone had thought,” Al-Lamee said. “This is a unique trial of its kind, and [it] will help us to develop a better perception of stable angina, a symptom that affects so many of our patients every day.”
Writing in a commentary, concluding the report, a cardiologist stated the “landmark” study has implications that “are profound and far-reaching.” “First and foremost, the consequences of [the study] show that there are no benefits” for the use of stents compared to drug therapy for patients who are suffering from stable angina, said Dr. David Brown, of Washington University School of Medicine in St. Louis, and Dr. Rita Redberg, of the University of California, San Francisco.
In fact, based on the latest findings, Brown and Redberg believe that stents may not be useful in most of the case scenarios even when a patient’s angina fails to get better with medications.
“Based on this data, all cardiology guidelines should be updated to minimize the recommendation for [stents] in patients with stable angina,” whether or not they also received conventional drug therapy, the doctors said.
According to Brown and Redberg, every year over a half-million patients in Europe and united states undergo stent procedure — and a minority of these patients experience potentially serious complications that can include heart attack, stroke, kidney injury and even death. It is irresponsible to Subject these patients to undue risks when no benefit can be achieved.
The editorialists concluded that physicians need to put more emphasis on drug therapy and efforts at improving the lifestyle of many heart patients — things like bad diets, lack of activity and smoking.

Life After Angioplasty – Your Guide to Angioplasty and Cardiac Stenting


Coronary angioplasty was developed in 1977 as an alternative to the much more invasive coronary artery bypass surgery as a way to open blocked arteries of the heart. For many patients, angioplasty can be a very effective treatment option, while other patients may be better suited for bypass surgery.
The blockages in coronary arteries can cause symptoms such as chest pain (angina) or shortness of breath. Sometimes, these blockages can result in a heart attack that can be successfully treated on an emergency basis with angioplasty. Angioplasty followed by stenting can restore the blood flow to the culprit artery.

Angioplasty – A Closer Look

Let’s get a closer look at the angioplasty procedure. Angioplasty is a minimally invasive procedure, unlike coronary artery bypass surgery, your chest does not have to be opened. The angioplasty procedure is performed by a Heart specialist known as an interventional cardiologist. A small incision is made, usually in the groin or sometimes in the wrist, and a thin, flexible tube called a catheter is then inserted into an artery. The catheter is carefully guided through the artery and it eventually reaches the coronary vessels.

A special dye is then pumped through the catheter and the cardiologist uses an x-ray machine to see if there are blockages. Once the blockage or blockages are located, an extremely fine wire is positioned within the blockage. Then a catheter with a small, deflated balloon is threaded over the wire to the center of the blockage. The balloon is inflated and deflated several times and this compresses the blockage against the walls of the artery to restore the blood flow.

Angioplasty is not a cure for coronary artery blockage because a blockage can return even after angioplasty. One way to prevent the recurrence of the blockage is to insert a stent at the time of the angioplasty to keep the artery patent. A stent is an extremely small mesh tube made of metal. The first stents were made of just bare metal, but currently, many patients receive stents that have been coated with a medication that is released into the surrounding tissue to prevent scarring and re-blockage of the artery.

Angioplasty Risks

All the procedures, even the safest ones, carry risks. Possible complications of angioplasty are bleeding, a heart attack, a stroke or even an allergic reaction to the dye, but fortunately the complication rate is under one percent for all patients. Also, In rare cases, the procedure has to be stopped and the patient is referred for coronary artery bypass surgery.
After the angioplasty has been completed, typically the patient stays in the hospital for twelve to twenty-four hours. It’s quite likely to have some bruising and discoloration at the site of the catheter insertion. The area is also likely to be a bit sore, the patient may also notice a small lump or some drops of discharge from the site.

Most angioplasty patients report feeling more tired than usual for several days after the procedure, especially if they were in the middle of having a heart attack, in this case, the tiredness can last for up to six weeks. The patient should call his consultant cardiologist if he begins to have chest pain that feels like the pain he had before the procedure. If the chest pain is prolonged, lasting fifteen or twenty minutes call 911. The physician should also be notified if patients begin to have bloody or pus-filled discharge from the catheter insertion site.

After Angioplasty – The First Few Weeks

let’s discuss what you can do to keep you and your coronary arteries healthy from now on.
As discussed earlier, angioplasty with or without stenting, is not a cure for coronary artery disease. Follow up with your physician is a must. The patient should also follow an approved exercise program, cardiac diet, and medications prescribed by his physician.

You should always follow your doctor’s instructions after angioplasty. Keeping that in mind, here are some general guidelines:

  • The patient should take all the medications exactly as prescribed.
  • For the first five days after the procedure, you should only do light activities. Walking and even climbing stairs and taking care of routine things at home is usually ok. Once the five-day period is over, the doctor will likely release you to a moderate level of activity but don’t overdo it with activities that lead to tiredness, shortness of breath or chest pain.
  • The patient should not lift heavy objects or do strenuous exercise for four weeks after the procedure.The patient should also get his physician’s clearance before undertaking heavy manual labor.

After Angioplasty – Lifestyle Changes 

Lifestyle changes are important for most people to prevent recurrence of the disease. If you smoke, immediately enlist your physician’s help to stop.

Most hospitals that offer angioplasty have a cardiac rehabilitation program and you should strongly consider enrolling. Patients who successfully complete a cardiac rehab program are more likely to be living and doing well five years after their angioplasty than those who don’t complete a program.
A heart-healthy diet is a must and physician can refer the patient to a nutritionist for help. This is doubly important if the person has high cholesterol problems or diabetes. In general, a diet low in saturated fats with plenty of fruits and vegetables and good sources of lean protein is recommended. Heart-healthy fats (high in omega-3 fatty acids) include walnuts, wild caught salmon, sardines, and flaxseeds, as well as flaxseed oil, should also be included in your diet in moderate amounts.
With proper nutrition, exercise and close follow up with your physician, your chances of leading a healthy and vital life after angioplasty and stenting are excellent!