A recent study in cardiology is getting a lot of attention. Headlines have sensationalized the results, claiming things like "medicine may work better than stents for patients with heart disease." An Associated Press article on this study was published in the Nov. 17 edition of The Paducah Sun, with the headline, "Study casts doubt on need for many heart procedures." I would like to make sure that you, our neighbors, our current patients and our potential future patients, have the facts.
ISCHEMIA was the name of the trial, presented recently at the national American Heart Association meeting. Its results were "negative," because patients who got stents placed in their heart arteries didn't have less heart attacks or live longer than those who "just" received medications. Patients who received stents did, importantly, have less chest pain. To us cardiologists, this comes as no surprise and is in fact, old news.
The disease in question here is "coronary artery disease." This condition occurs because plaque build-up narrows the vessels that supply the heart with the blood that it needs to do its job -- pump blood throughout the body. This disease can manifest in two distinctly different varieties, and this is a key concept in discussing this study.
First, when plaque "goes haywire," it ruptures and the blood flowing though that vessel clots, resulting in further narrowing of the vessel (perhaps even to the point of a complete blockage -- no blood flow getting past that point). This results in sudden onset of symptoms that are a heart attack.
Secondly, when plaque grows over time to the point of severely narrowing the vessel, but does not abruptly change, it can cause chronic, predictable symptoms like chest discomfort or shortness of breath with activity. Notably, the latter of those scenarios is referred to as "stable" ischemic heart disease. The ISCHEMIA trial was studying patients with stable heart disease (i.e. not a heart attack).
As I tell all my patients, stents (which are small metal "tubes" inserted to relieve open blockages in the heart arteries) do one of two things: 1) if you're actively having a heart attack (whether a "big" or "little" one), stents have long ago been proven to make you live longer, and 2) if you have chronic symptoms from a blocked artery, a stent can make you feel better by relieving that blockage.
This new study confirms just that -- if you are having chronic symptoms from a blocked heart artery, we should try medicines first to hopefully make you feel better. If that fails, a stent can help. This was what the study showed, and it confirmed that stents for patients with chronic symptoms don't prevent heart attacks or death.
This has been our practice since a study called COURAGE was published in 2007. The key to preventing heart attacks is not stents, it's managing your cholesterol, blood pressure, and blood sugar, not smoking, eating a heart-healthy diet, and exercising.
But if you're having a heart attack, don't let the headlines with this study fool you -- stents remain the best way to stay alive.
Dr. Martin Rains is an interventional cardiologist employed by Baptist Health Medical Group Heart Group.