For patients with acute coronary syndromes (which are produced by the sudden rupture of a coronary artery plaques, leading to acute blockage of the artery, and often causing an acute heart attack or unstable angina), immediate angioplasty and stenting can reduce the damage to the heart muscle and can help prevent subsequent heart attacks.
But for patients with stable CAD, who often have partial blockages in their coronary arteries and episodes of stable angina, stenting does not seem to reduce the risk of subsequent heart attacks or death any more than aggressive, non-invasive, medical therapy. In these patients, stenting is effective at treating symptoms of angina, but otherwise does not alter the subseqent clinical outcomes. Nonetheless, it is estimated that between 70% to 80% of all stents are used in patients with stable CAD.
When the COURAGE trial was published in 2007, showing that stenting does not measurably improve outcomes in patients with stable CAD, prominent cardiologists declared that they had known this all along, and that their reason for using stents in these patients was, indeed, solely for relief of angina (which, they also allowed, can most often be achieved with medical therapy alone).
Yet interestingly, in a study presented by Dr. John Lee at the American Heart Association Scientific Sessions in 2008, the large majority of 500 patients surveyed after receiving stents for stable CAD had the wrong impression about the benefits of their stents. As many as 33% believed that their stents had been necessary on an emergency basis; 71% believed their stents would help prevent heart attacks; 66% believed the stents would help save their lives; and 42% believed that the stent had already saved their lives.
Subsequent online conversations among cardiologists as to how stented patients could come away from the experience with such silly notions have been inconclusive. Most cardiologists seem to blame it on the patients themselves, who, they suggest, are jumping to unwarranted conclusions, despite the (apparently) clear explanations of benefits and risks given to them by their doctors.
Obviously, there is another possible explanation.
Let's see what readers of this website have to say about this question. If you have actually received a stent for stable CAD, please consider telling us the reason you were given by your cardiologist for needing a stent.
Please click on the link (under "Readers Respond," below) to participate.
Source:
Wood,S. Patients believe elective PCI prevents MI and saves lives, but who's to blame? TheHeart.Org, November 12, 2008. Available at: http://www.theheart.org/article/920657.do
