Drugs Work as Well as Angioplasty, Study Says

JIM LEHRER:

Now, the growing debate over the use of stents. More than one million Americans a year get a stent — or a tiny metal scaffold — implanted in a clogged artery in a process known as angioplasty.

But a new study of more than 2,000 patients found that, in non-emergency situations, treatment with stents and drugs was no better than simply using medications alone to prevent heart attacks and death. The study has been stirring up much discussion at the annual meeting of the American College of Cardiology in New Orleans.

Dr. Steven Nissen is the outgoing president of that organization.

Dr. Bonnie Weiner is the president-elect of the Society for Cardiovascular Angiography and Interventions.

Did I say that right, Dr. Weiner, angiography?

DR. BONNIE WEINER, Society for Cardiovascular Angiography and Interventions: Angiography.

JIM LEHRER:

Angiography. Well, I was close. All right.

Dr. Nissen, starting with you, is the simple message of this study that there are too many stents being used?

DR. STEVEN NISSEN, American College of Cardiology: I wouldn't characterize it that way. I think what we learned is some very important lessons about what to expect from stenting and what not to expect.

We know that stents do, in fact, help to relieve chest pain, but they really do not prolong life or reduce the risk of a heart attack in patients that are otherwise stable.

What was really surprising about the study is that both the medically treated patients — those that got drugs and lifestyle counseling — had a major reduction in the amount of chest pain they had. And that was almost the same between the group that got the stents and the group that got medicines alone.

This enables us to start with medicines and reserve stents for those people who need them the most.

JIM LEHRER:

Dr. Weiner, do you see it the same way?

DR. BONNIE WEINER:

I don't, actually. These are very stable patients and really don't represent the majority of patients we treat. And despite that, they clearly had a benefit, in terms of reduction in chest pain and quality of life.

And a third of the patients who actually were treated with medicines initially wound up having angioplasty or stents or bypass surgery over the course of the follow-up period.

JIM LEHRER:

What about the connection, Dr. Weiner, between stents, medicine, whichever? Usually they're both, right? It's not either/or? Am I correct, first of all?

DR. BONNIE WEINER:

That's correct. Medicines really are the underpinning of everything we do, so that it's definitely not a competition between medicines and angioplasty.

JIM LEHRER:

All right. The use of stents and/or medicine, what is the connection, provable thus far, between preventing heart attacks and particularly those that cause death?

DR. BONNIE WEINER:

Well, we've never said that angioplasty was designed to reduce death or reduce the incidence of heart attacks, in this particular group of patients, who are quite stable. So this really doesn't come as a surprise to us.