Drugs Before Stents for Stable Heart Disease, Study Says

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People with stable coronary artery disease, he said, should not expect angioplasty, with or without use of a stent, to affect mortality or the occurrence of a heart attack.

"Rather, regardless of whether a patient requires angioplasty for symptoms, all patients should continue, as a primary treatment, to focus attention to aggressive risk factor modification," Moliterno said. "In other words, it's not just about the current severe blockages but about the underlying pathology causing the blockages."

Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, said he agrees that invasive procedures should be reserved for people with unstable cardiac problems.

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"Percutaneous coronary interventions have been demonstrated to substantially improve clinical outcomes in patients with ST segment elevation, acute myocardial infarction and, in select groups of patients, with unstable angina and non-ST segment elevation acute myocardial infarction," Fonarow said. "Percutaneous coronary intervention is evidence-based, guideline-recommended therapy for these indications."

Though angioplasty might reduce symptoms in some people with stable coronary artery disease, he said, no individual study has demonstrated a comparative reduction in the number of heart attacks or deaths.

"This new meta-analysis demonstrates that balloon angioplasty, bare-metal stents and drug-eluting stents do not improve the clinical outcomes of death or myocardial infarction compared to medical therapy," he said.

Most people with stable coronary artery disease "are better off with initial treatment with optimal medical therapy, reserving percutaneous coronary intervention for those patients with persistent symptoms despite optimal medical therapy," Fonarow said.

Another report in the same issue of The Lancet found that, after two years of follow-up, bioabsorbable polymer drug-eluting stents, which are reabsorbed by the body, were safe and effective.

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