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Stenting better than medication alone early on in heart disease, study finds

For many patients with stable heart disease who would normally be treated with medication alone, inserting a vessel-opening stent into narrowed heart vessels could be a better treatment option, according to a multi-center study published today in Circulation.

In the study, which followed 888 patients for three years who received either medication alone or stents, those who had the stents inserted early on were found to have significantly less chest pain and fewer urgent hospitalizations.

In addition, while stenting was more expensive up front, after three years the costs evened out. This was primarily due to the reduced need for hospitalizations and urgent stenting procedures in those who received early stents, said William Fearon, MD, professor of cardiovascular medicine at Stanford and lead author of the study. About 50 percent of those who received medication alone eventually needed emergency stenting, he said.

"We believe these findings will significantly impact the approach to managing patients with chest pain and coronary disease," Fearon said.

Coronary heart disease, which is caused by the buildup of plaque in arteries to the heart, is the top cause of death in the United States. Millions of people are in treatment for the disease. For the past decade, much controversy has swirled around the best use of stents — small mesh tubes used to prop open narrowed or weakened arteries. Scientists, such as Fearon, have been conducting research to help provide evidence-based answers to clear up the debate.

“Cardiologists are often criticized for unnecessarily placing these stents because the physician receives reimbursement for this procedure,” said Fearon, who is a cardiologist. His studies have focused on the use of fractional flow reserve technology to help determine when it's appropriate to insert stents and in which vessels. The technique involves inserting a coronary pressure guidewire into the artery to measure blood flow during a coronary angiogram.

The study showed that by using this technique, it's possible to identify the patients with stable heart disease who would benefit from a stent, rather than solely taking medications, including aspirin and statins. Medications are currently considered the best treatment for stable disease.

“People feel better and do better with the FFR-guided placement of coronary stents up front,” Fearon said. “This study shows that there is also no increased cost after three years so there is no reason not to do the stenting up front.”

Previously: Guidewire technology improves heart patient care, New tool for heart disease saves both lives and money and Stanford researchers describe experimental treatment for deadly heart disease
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