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Stent insoles or bypass surgery are among the most common invasive procedures for treating coronary heart disease. But whether they are always necessary is unclear.
US researchers have now found in a large-scale study that patients with stable coronary heart disease often do not benefit from the intervention: a drug therapy and general lifestyle adjustments can be as effective for her as surgical measures.
Narrowing in one or more coronary arteries is often due to arteriosclerosis and can lead to hypoxia in parts of the heart. Physicians speak of coronary or ischemic heart disease (CHD). These are among the most frequent causes of death in Germany. Dangerous consequences are also cardiac arrhythmias, heart failure or an infarction.
In addition to eating well, abstaining from cigarettes, and exercising well, medications can help dilate blood vessels and improve oxygen utilization. Also, the effective treatment of hypertension or diabetes mellitus belong to a comprehensive therapy.
In addition to these treatment options, the vessels can also be kept open by inserting stents. Stents are small mesh tubes that are placed over a cardiac catheter in the narrowed coronary arteries. Newer coated stents also provide drugs that are designed to prevent the vessels from re-growing. Their use is controversial, as patients often have to undergo surgery again after the intervention. In open heart bypass surgery, one or more coronary vessels are replaced by veins from the legs or arteries from the chest wall (Read more about stents here).
For chest pain, stents can help
The International Study of Comparative Health Efficiency With Medical and Invasive Approaches (ISCHEMIA), funded by the New York NYU Langone Health Center, has now come to the following conclusions:
- Stents or bypass surgeries do not protect better from heart attacks or deaths from cardiac arrest than medications.
- However, the procedures demonstrably provide relief for patients with chest pain .
- In people without chest pain , they have no advantage over a drug therapy.
The study involved 5,179 people who had narrowed arteries but were not in need of health care. Every fifth of them complained of regular chest pain. The treatment methods of the patients were selected at random: a single drug therapy, the insertion of stents or a bypass surgery.
145 patients with a stent or bypass died, 276 of them suffered a heart attack. Of the patients who only took medication, 144 died and 314 suffered a heart attack. The researchers, who presented their findings at an American Heart Association meeting over the weekend, concluded that there is not much difference between invasive and drug therapies for stable coronary heart disease - except for the relief of chest pain.
MORE ON THE SUBJECT
Previous studies incomplete
The results also seem to have convinced physicians: "Study results will change our clinical thinking," said Alice Jacobs, cardiologist at Boston University, the New York Times.
It has long been a controversial issue whether stent implantation is the better solution for patients with stable coronary heart disease compared to drug therapy. In 2007, a study had already suggested that stents are no more effective than cardiac drugs. However, there was only one debate about the correct use of stents - the study was considered inconclusive by doctors and the study design was found to be faulty.
Overall, results from the ISCHEMIA study suggest that stents and bypass surgery should be used more sparingly in patients with stable heart disease. The decision on invasive procedures should also be made less hastily. Patients with regular chest pain may still be able to alleviate the invasive measures.
In summary, US scientists have found that surgery for stable coronary heart disease is often superfluous: a drug-only comparator group did not suffer more heart attacks or died of the disease than those receiving stent inserts or a bypass , Only invasive procedures can relieve chest pain that can not be achieved with medication alone. The study thus underlines earlier study results, which were doubted because of the study design of doctors.