[x] close

Like this on Facebook

Coronary Artery Disease | Heart News
_____heart-vascular-health

Stents – One Size Doesn’t Fit All

A million Americans a year get stent treatment, which involves inflating a balloon to clear a blocked artery and implanting a small mesh cylinder to hold it open

This article is more than 2 years old.
There may be more recent information available.

PCI (percutaneous intervention) is a treatment for angina, or chest pain. A million Americans a year get this treatment, which involves inflating a balloon to clear a blocked artery and implanting a small mesh cylinder (stent) to hold it open.  But does PCI do any good?  Not according to a new study, which appears to show that PCI is no better than pharmaceutical treatment for “stable” angina – transient chest pain associated with stress or exercise.

As reported in the New York Times, “The researchers reviewed eight randomized trials comparing PCI 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 PCI and death.”

This conclusion comes as no surprise to Cleveland Clinic cardiologist, Stephen Ellis, MD.  “We’ve long recognized that medicines rather than PCI are the best protection against heart attack for stable patients,” says Dr. Ellis. “We also know that for another category of patients, those who are unstable and threatened with heart attack, PCI is better than medicines.”

More controversial is Stony Brook’s finding that the chest pain didn’t go away for 29-33 percent of patients who had either medicine or PCI. Dr. Ellis has problems with this conclusion, as well as the study’s methodology.

“The study purports to show that PCI doesn’t even prevent angina in these patients, but the analysis doesn’t stand up to close reading,” he says. “It would have been more instructive if the study had provided results based on the patients’ initial level of angina. At least a third of patients in these studies had no or minimal angina to start with, as physicians in general are reluctant to possibly randomize highly symptomatic patients to medical therapy alone. Not surprisingly, medicines alone were able to keep angina at bay in these patients. Second, these studies enrolled patients 1997-2005, so in some cases stents weren’t even used. Finally, almost no patients received drug-eluting stents, which are known to reocclude 70-80 percent less frequently than after balloon angioplasty or non-drug-eluting stents.

Dr. Ellis points out that PCI reduced recurrent angina by a nearly-statistically significant 21 percent in the study. Other studies have shown a greater reduction when angina is more severe to begin with.

“Cardiologists know that contemporary stents have a limited role for treatment of patients with limited symptoms,” says Dr. Ellis. “However, for patients with lifestyle-limiting angina that is resistant to medical therapy, stents can — and do — safely relieve symptoms.”

Cleveland Clinic now offers same-day appointments. Get the care you need, right away at 888.223.CARE.

We welcome your comments. However, we cannot provide a medical opinion without an in-person consultation. To learn about Cleveland Clinic services available to you, please fill out our WebMail form.
  • http://N/A Bob Holtz

    To the Cleveland Clinic and their Cardiology Department: To Dr Gillinov & Dr. Ellis MD. I came across research on E.D.T. A Chelation Therapy Dated July 15, 2006. The Case For Intravenous E.D.T.A. Ch elation Therapy. Dr. Martin Dayton is a strong proponent for E.D.T.A. Ch elation Therapy for the purpose of eliminating the main cause of heart disease called Plague. I have compiled with the help of two librarians a supporting study and research to conclude that there is more than enough information to support Dr. Martin Dayton claims. I am also a cardiac patient with two cardiac stents in two of the main heart arteries and i believe i have strong reason for concern in that this procedure has little or no effect in addressing the real problem. Plague ! The research i have is large enough to fill a size-able three ring binder having all the necessary protocols in conducting a proper study including double blind studies, null hypothesis all 102 of them, And the at this time there are over 1000 doctors here in America who prefer to use this E.D.T.A. Ch elation Therapy for a first line of defense for heart patients instead of Cardiac Stents , or Triple Bypass surgery. My feeling is that most doctors no matter what their specialty my be, They in no way will go beyond their mandated medical protocols in order to fine what works and actually cure the patient instead of only dealing with the symptoms and preforming medical procedures that amount to a quick fix having negative long term effects of doing just the opposite of what the medical procedure is suppose to do . It is time that 21st Century medicine and 21st century doctors stop practicing medicine for that is the thing of the past and start applying pref romance base medicine that has actual positive CURES for all of 21st century diseases We Americans are suffering from. Consider this the American Doctors here in this 21st century have been made available to them more extensive research bar none, The most Advance Technologies that surpass the best of the best, Along with the most Advance medical lab microscopic testing , And the best medical facilities known to man kind, More than all their predecessors combine, And yet the cure rate is dismal at best ! Why ? Please let us all take a good look at where we at, and move froward in the direction of positive action in the health of the American People our future depends on it. Amen.

    1. E.D.T.A. Chelation Therapy
    2. Food Grade 35% Hydrogen Peroxide Therapy.

    Do The Research ! And Keep a open Mind.

    • CC Heart

      Dear Bob, Dr. Nissen, Chairman of Cardiovascular Medicine states: Chelation therapy is not a useful treatment for patients with heart disease and it can be dangerous. Every major federal agency and medical group, include the FDA and American Heart Association has warned that chelation has no benefits for heart patients and can result in death. Approximately 30 patients have been killed by chelation therapy in recent years. The proponents of this treatment operate on the fringes of medicine and take advantage of desperate patients, often bilking them out of their life savings. Some of practitioners have been prosecuted for criminal acts, but most operate just on the edge of legality. Do not be fooled. Chelation is an ineffective and potentially dangerous therapy used by questionable practitioners who operate on the fringe of the law.

      In addtion, Dr. Ellis states: Many treatments in medicine may sound like they ought to work, but until they are subjected to the rigor of randomized clinical trial wherein patients are randomly allocated to treatment or placebo and they are followed to ascertain benefit one should be skeptical- especailly if physicians can charge a lot of money for the treament. There have been 7 randomized trials of chelation therapy for atherosclerosis. It’s hard to see why anyone would pay good money for a treatment with such a record, especially when fatalities due to hypocalemia have been reported with this therapy.