Heart Patients Seek Guidance on Stents, Statins

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Gibbons, who is also professor of medicine at the Mayo Clinic in Rochester, Minn., stressed that the trial had to pass muster not only with the ACC but with the tough peer-review board at the New England Journal of Medicine, which published the results this week.

"Mayo, where I work, was a center in this trial," he added. "If we had had any concerns about the study's design, we would not have participated."

Gibbons stressed that the findings only apply to patients with chronic but stable heart disease. These patients may experience intermittent chest pain (angina) but have no history of heart attack.

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"We need to recognize that the study does not apply to acute heart attack [patients]," he said. The study also does not apply to patients with stable heart disease whose chest pain has not responded to medicines, Gibbons added. Both of those groups are very appropriate candidates for invasive procedures such as angioplasty, he said.

According to Siegel, in too many cases, patients with stable heart disease are routinely sent off for an angiogram. And once doctors notice an obstruction -- any obstruction -- their temptation is to surgically remove it.

"There's clearly a gut reaction when you see a closed artery -- that it's better to have it opened," said Siegel, who is also clinical assistant professor at New York University School of Medicine. "But the trouble with the whole concept of 'opening everything' is that it does nothing for the underlying disease."

Angioplasty and stents both come with risk, he said, and the new study shows that, in many cases, it may be best to resist that urge to perform surgery and see if medicines can do the trick on their own.

Another expert agreed. "If you are having really horrible chest pain with exertion, it may be appropriate to have a stent, but too often, they are being done with just the promise of preventing a heart attack, and they don't do that," said Dr. Arthur Agatston, an associate professor of medicine at the University of Miami School of Medicine. He said he rarely treats chronic heart disease patients with stents, preferring medication and lifestyle change instead.

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