More than half a million Americans undergo a procedure to receive a heart stent each year. A stent is a small, mesh, metal tube that is placed in a blocked artery to improve the blood flow to the heart.
“Stents are placed to open arteries of the heart that have blockages causing heart attacks or angina, which is chest discomfort from the heart muscle not getting enough oxygen,” says Dr. Jay Pandhi, a cardiologist affiliated with Sharp Chula Vista Medical Center. “Once placed, stents develop a ‘skin’ over them and become a permanent scaffolding holding the artery open.”
Stents placed in patients having heart attacks can save their lives. However, a recent study found that stents may not be necessary for those experiencing mild chest pain or blockages.
Researchers at Imperial College London treated 200 patients experiencing chest pain and a clogged coronary artery. All received medications to reduce the risk of heart attack and relieve chest pain. However, only half of the patients underwent a stent placement procedure and received a stent while the other half unknowingly underwent a mock procedure, during which no stent was placed. All 200 patients were then treated with drugs to prevent blood clots.
When tested six weeks later, both groups — those with stents and those without — had similar outcomes. All patients experienced less chest pain and performed better on treadmill tests than they had prior to the procedure. These findings have led some to question whether stenting is appropriate for all patients with chest pain and a blocked artery.
“I think that this study was well-done and will impact how cardiologists manage their patients with heart disease in the future,” says Dr. Pandhi. “Most significantly, I feel that this study demonstrated the significant placebo effect that procedures can have on patients. Physicians will need to take this into account before referring patients for procedures that have potential risks.”
Stents and the related procedure to place them carry a small risk of serious complications, according to the National Heart, Lung, and Blood Institute (NHLBI). These risks include blood clot, which can cause heart attack or stroke; damage to the blood vessel; irregular heartbeat; damage to the kidneys by the dye used during the procedure; and infection.
Dr. Pandhi advises patients to have an open and honest discussion with their cardiologist about their symptoms, goals for care, and concerns. In some situations, such as a heart attack or unstable coronary syndrome, a stenting procedure may be the best course of action, and can help alleviate symptoms and reduce the risk of death.
However, Dr. Pandhi believes that in other more stable situations, it is appropriate to attempt lifestyle changes and medical therapy as an initial approach to care. “The patient is the most important person in the health care team, and it is important for the cardiologist to understand a patient’s concerns and goals in discussing the options available for treatment,” he says.
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