I Want To Love Stents, I Do!

Tuesday, March 27th 2007
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I want to love stents. But how can you as the evidence mounts?

As The Health Care Blog predicted (here’s the pre-study release New York Times story), stents appear to be overused. Researchers presenting findings from the COURAGE study at the annual meeting of the American College of Cardiology found that,

patients who received stents to prop open coronary blood vessels in addition to being treated with statins and other heart drugs during a five-year clinical trial had better blood flow to their heart than those treated only with drugs. But they did not live longer or have fewer heart attacks.

That finding confirmed the results of smaller trials. In this study, however, researchers also found that the one previously unquestioned advantage of stenting — better relief from the chest pain, shortness of breath and other symptoms from arteries that are clogged — disappeared over time even though the implants were highly successful at improving blood flow.

But It Works So Well In This Graphic!

Johnson & Johnson, a major stent manufacturer, is already on the defensive,

Examples of how the results might be questioned emerged even before the data itself. Dr. David Kandzari, chief medical officer for Cordis, Johnson & Johnson’s stent subsidiary, noted that the more than 2,200 patients in the trial came largely from Veterans Administration hospitals in the United States and Canada — groups that get many medicines for free and are therefore more likely to take them as prescribed. Moreover, compliance with drug prescriptions is more common in clinical trials than in everyday life.

Other shortcomings might be that 85 percent of the patients were male and 86 percent of them were white.

The major argument against taking all the findings of this study with one big gulp, and a comment I’ve made before, is that all of those enrolled in the study recieved bare metal stents. It speaks nothing to the newer drug coated stents (although those have taken a beating with the increased risk of thrombosis). It also says nothing about how the benefits of stenting might increase with newer stents.

A new crop of experimental heart stents have passed some key safety and effectiveness tests and may one day offer alternatives to the controversial stents currently used to keep unclogged arteries open, doctors reported Saturday.

One is designed to dissolve after doing its job, leaving nothing behind to trigger blood clots - a worry with the most popular stents sold now. Another attracts special cells to help the artery heal. A third is super-thin and uses a novel drug to keep scar tissue from reblocking the vessel.

We need to give the technology more time before running it out of town but there doesn’t appear to be any doubt with this study (and others) that stents are overutilized.