Stenting – What’s a Patient to Do?

There’s been a flurry of reports about stenting at meetings and in print recently, carrying confusing messages for the lay-person (and for some physicians, too!). One of the most recent studies to be reported (at the American College of cardiology meeting and published in the New England Journal of Medicine) is regarded as fairly conclusive, although doubtless other results will be forthcoming to renew the confusion.

The COURAGE trial was done in over 2,200 patients with stable angina – i.e. chest pain on exertion, but not at rest. Half the patients received coronary stenting plus optimal medical therapy, while half received optimal medical therapy alone. After 4½ years death and/or heart attack were reported in 19% of the stenting group vs. 18.5% of the medical therapy alone group. And there were no significant differences in the rates of stroke or hospitalizations for acute coronary syndrome. An economic analysis indicated that the cost of one quality-of-life year gained was at least four times greater for the stenting group.

Based on these results, cardiologists can rest assured that they are not putting patients with stable angina at risk if they recommend optimal medical therapy as initial treatment.

We must not throw out the baby with the bathwater. Stenting is proven as being good for a number of other conditions: carotid artery atherosclerosis, renal hypertension, peripheral artery disease, and, of course, unstable angina due to severe coronary artery disease. But if your cardiologist is urging you to have stent placement for stable angina, get a second opinion first.