For patients with coronary artery disease who are interested in being proactive in their own health care, I’ve written a series of stories on published studies co-authored by Stanford cardiologist William Fearon, MD, that might provide some helpful insight.
Fearon’s ongoing research has delved into the potential benefits of using a somewhat new technology called “fractional flow reserve,” or FFR, to determine most accurately which heart patients need artery-opening stents – those small tubes inserted into weakened arteries to increase blood flow to the heart.
Coronary heart disease, also called hardening of the arteries, which is caused by the buildup of plaque in the arteries to your heart, is the biggest killer of men and women in the United States. So new research that helps in determining accurately when a stent is needed can help prevent heart attacks or even death.
Fearon’s most recent study, published today in the New England Journal of Medicine, found that the FFR technology (which involves inserting a coronary pressure guidewire into the artery to measure blood flow) can help pick out which patients with stable coronary artery disease need early placement of artery-opening stents rather than being treated with only medical therapy – aspirin or statins. Fearon explains the significance of the results in my story:
We believe there is a significant proportion of patients who benefit from stenting early on as opposed to receiving only medical therapy ... For this group of patients who have significant ischemia [blood vessel narrowing that compromises flow to the heart muscle] based on assessment with FFR, the need for hospitalization and urgent revascularization is much higher and the pain relief is much less when only medical therapy is prescribed. People feel better and do better with FFR-guided placement of coronary stents up front in this setting.
In a story on a previous study (FAME 1), I reported that the study results showed FFR can actually reduce the number of stents, which have their own risky side effects:
The study suggests that doctors should go one step beyond the traditional method of relying solely on X-rays from a coronary angiogram to determine which arteries should be stented for patients with coronary artery disease. In many cases, cardiologists will routinely prop open with a stent any arteries that look significantly narrowed on the angiogram, said Fearon. 'The problem is you can’t always tell from the angiogram whether this is absolutely necessary.'
The question that has nagged at me since learning about this research, is whether patients with hardened arteries should insist that their doctors use FFR. The cost is low, especially if it leads to the decision that a stent which costs $2,000, is not needed as reported in another Fearon study. And, Fearon says, the technology itself is now available in most hospitals. But it’s still not routinely used, and it's not clear how well trained cardiologists are in its use.
"For a patient who is going to be having a coronary angiogram because of chest pain, they certainly can ask their cardiologist about it," Fearon says. "Make sure there is someone who is comfortable and trained in using a pressurewire."