Drugs Before Stents for Stable Heart Disease, Study Says

Most important, expert says, is to aggressively try to reduce risk factors

By Steven Reinberg
HealthDay Reporter

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THURSDAY, March 12 (HealthDay News) -- Treating people with non-acute heart problems should start with drug therapy, not invasive techniques such as angioplasty or implanting stents, because there is no difference between the two approaches in outcomes, a new study finds.

There has been an ongoing debate over whether initial treatment of people with non-acute heart problems should be with drugs or whether it would be better to open blocked heart arteries with a catheter -- called percutaneous transluminal balloon coronary angioplasty -- with or without a bare-metal or drug-coated stent, a wire mesh tube used to prop open an artery.

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"In the short run, angioplasty procedures among stable patients can improve symptoms but are not lifesaving," said Dr. David J. Moliterno, chief of cardiovascular medicine at the University of Kentucky's Gill Heart Institute.

"To improve life span takes more than a few minutes in the catheterization laboratory," he said. "Rather, a lifetime of change is usually needed."

The report was published in the March 14 issue of The Lancet, in advance of an American College of Cardiology meeting in Orlando, Fla. Moliterno wrote an accompanying editorial in the journal.

For the study, a team led by Dr. Thomas A. Trikalinos, from the Institute for Clinical Research and Health Policy Studies at Tufts Medical Center in Boston, identified 61 clinical studies that compared medical therapy, or drug treatment, with angioplasty and stents. The trials included a total of 25,388 people. The researchers documented deaths, heart attacks and cardiac bypass surgeries, and repeated procedures after initial treatment.

They found that angioplasty and either bare-metal or drug-coated stents did not result in fewer deaths or heart attacks compared with medical therapy.

"The reason for the similar outcome is likely that these hardest endpoints occur at a relatively low rate among stable cardiac patients when followed for a short period of time and are more affected by risk factor and lifestyle modifications," Moliterno said.

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