For patients with stable coronary artery disease (CAD), stent placement offered no more benefit than optimal medical therapy, according to a meta–analysis by Kathleen Stergiopoulos, MD, PhD, and David Brown, MD, of
in Stony Brook, N.Y reported in the journal Archives of Internal Medicine. Stony
Stents had no significant effect on the risk of nonfatal myocardial infarction, unplanned revascularization, or persistent angina. The current guidelines prefer initial medical treatment with aspirin, statins, angiotensin–converting enzyme inhibitors (ACEIs), or angiotensin receptor blockers (ARBs), combined with lifestyle changes. The researchers included eight trials with a total of 7,229 patients, including the landmark COURAGE trial. For a study to be included, at last half of the patients assigned to PCI had to have been given a stent; the proportions ranged from 72% to 100%. The death rate for stent implantation was 8.9% compared with 9.1% for medical therapy. The rates for nonfatal MI were also similar –– 8.9% for stents and 8.1% for medical therapy. The rate of unplanned revascularization in the stent group was 21.4%, compared with 30.7% in the medical treatment group. The rates of persistent angina were 29% for stents and 33% for medical therapy.
Up to 76% of patients with stable CAD can avoid PCI altogether if treated with optimal medical therapy.
Simply putting in a stent in a blockage does not address the underlying problem. Lifestyle changes and aggressive medical management are far more important than just putting in a stent.