NEW YORK (CBSNewYork) — There has been a major breakthrough on bypass surgeries and stents.
A new study calls into question the medical care provided to tens of thousands of heart disease patients with blocked coronary arteries.
“This was really a blockbuster trial, that was just presented at the American Heart Association meeting, and really highly anticipated by cardiologists,” CBS This Morning medical contributor Dr. Tara Narula said.
With 5,179 participants followed for average of three and a half years, the Ischemia trial is largest trial to address the effect of opening blocked arteries in non-emergency situations and the first to include today’s powerful drug regimens, which doctors refer to as medical therapy such as blood pressure-lowering drugs and aspirin.
One of the experts involved in the study is Dr. Judith Hochman, the senior associate dean for clinical sciences at NYU Langone Health.
“It’s very likely that the study results will lead to less cardiac catherizations, less stents and bypass surgery in patients that are stable whose symptoms can be well-controlled with medicines,” Hochman said.
Local cardiologists point out this doesn’t mean there’s no role for these procedures. It will just depend on each individual patient.
“This study was for the gray area, the patients who are stable with heart disease. What do we do with them?” Lenox Hill Hospital’s Dr. Satjit Bhusri told CBS2’s Andrea Grymes.
In the study, all the patients had moderate to severe blockages in coronary arteries. Most had some history of chest pain, although 1 in 3 had no chest pain in the month before enrollment in the study. In addition, 1 in 5 experienced chest pain at least once a week. All participants were regularly counseled to adhere to medical therapy.
The number of deaths among those who had stents or bypass was 145, compared to 144 among the patients who received medication alone. The number of patients who had heart attacks was 276 in the stent and bypass group, compared with 314 in the medication group, an insignificant difference according to doctors.
Stenting costs an average of $25,000 per patient. Bypass surgery costs an average of $45,000 in the United States. The nation could save more than $775 million a year by not giving stents to the 31,000 patients who get the devices even though they have no chest pain.
“The trial provides very important information, evidence for patients and their physicians to share decision making,” Hochman said. “They now know the risk of these heart-related events and they know what they can expect in terms of improvement in their chest pain, their angio symptoms. So together they can decide what the best strategy is for them.”
Mount Sinai Hospital’s Dr. Samin Sharma praised the latest research, but cautioned patients to read the fine print.
“Yes, initial strategy of medical therapy is completely fine, but if you continue symptoms it’s better off to go to the cath lab and get it fixed,” Sharma said.
Patients with abnormal stress tests should talk to their doctors about the options. If a patient has chest pain despite taking recommended medications, a stent or bypass might help improve quality of life.