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.