No Extra Benefits Are Seen in Stents for Coronary Artery Disease - NYT
Whodathunk it? Apparently it's pretty much all about the money, money, money.
No Extra Benefits Are Seen in Stents for Coronary Artery Disease
By NICHOLAS BAKALAR
Published: February 27, 2012
The common practice of inserting a stent to repair a narrowed artery has no benefit over standard medical care in treating stable coronary artery disease, according to a new review of randomized controlled trials published on Monday.
Stable coronary artery disease is the type of heart ailment that causes angina, or chest pain, after physical exercise or emotional stress but generally not at other times. The review did not include studies of the emergency use of stents for heart attacks.
Stent implantation involves a procedure called percutaneous coronary intervention, or P.C.I., in which a surgeon inserts a mesh tube made of metal into an artery that has become narrowed by accumulated plaque. The tube, threaded through an artery in the leg or arm, expands to hold the artery open at the point where blood flow is restricted.
Some of these devices, called drug-eluting stents, are coated with medicine that helps to keep the artery open. The cost of the procedure varies from about $30,000 to $50,000, and more than one million are performed every year in the United States.
The procedure has certain risks. According to Dr. David L. Brown, an author of the analysis, the risk for death is about one in a thousand, and complications can include stroke, heart attack, bleeding, kidney damage and serious allergic reactions. But those events are rare, and the review did not detect any increased risk in P.C.I. compared with medical treatment.
Despite the widespread popularity of the procedure, previous studies have reached mixed conclusions as to whether stents are effective for treatment of stable coronary artery disease.
The researchers reviewed eight randomized trials comparing P.C.I. with standard medical care. Combining data from all the studies, the researchers found that prescribing beta blockers, ACE inhibitors, statins and daily aspirin — now standard for treatment of stable coronary artery disease — was just as effective as stent implantation for prevention of chest pain, heart attack, the need for a future P.C.I. and death.
More than half of patients with stable coronary artery disease are now implanted with stents without even trying drug treatment, Dr. Brown said. The reason, he believes, is financial.
“In many hospitals, the cardiac service line generates 40 percent of the total hospital revenue, so there’s incredible pressure to do more procedures,” he said.
“When you put in a stent, everyone is happy — the hospital is making more money, the doctor is making more money — everybody is happier except the health care system as a whole, which is paying more money for no better results.”
Dr. Allan Schwartz, chief of cardiology at Columbia, who was not involved in the study, said that the analysis reinforced what was already known — that treatment with medicine first is usually the best approach.
“I agree with the conclusions,” he said, “but they shouldn’t be oversimplified. Cardiac disease is complicated, and there are lot of factors tha
http://www.nytimes.com/2012/02/28/health/stents-show-no-extra-benefits-for-coronary-artery-disease.html?pagewanted=all&_r=0
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