New study clarifies benefits of coronary stents

September 12, 2012 by Quinn Eastman
New study clarifies benefits of coronary stents
Fractional flow reserve is a way of assessing the effects of blockages in blood flow in a coronary artery.

(Medical Xpress)—Who should get stents, the tiny metal tubes designed to keep once-clogged coronary arteries open? Someone who is having a heart attack certainly should, and the life-prolonging benefits have been demonstrated in several studies. But results have been more ambiguous for patients who have "stable angina": chest pain that comes with exertion but goes away at rest.

A recent study addressing this topic called FAME 2 has received extensive media coverage. It was published in the and also presented at the European Society of Cardiology meeting in Munich. Kreton Mavromatis, MD, director of at the Atlanta VA Medical Center and assistant professor of medicine at Emory, was a co-author on the NEJM paper.

In the new study, researchers used a technique called fractional (FFR) to decide if someone with stable angina should get a stent, or receive with drugs such as aspirin and statins. Conventionally, X-ray is used to assess the need for a stent.

FFR involves introducing a pressure sensor via guidewire into the , to measure how much blood flow is being blocked. FAME 2 was sponsored by St Jude Medical, a company that makes guidewire equipment for use in FFR.

The clinical trial was stopped early because of clear differences in the rates of hospitalization (4 percent for stents with medical therapy against 13 percent for medical therapy only).

"FAME 2 showed that the strategy of treating stable with FFR-guided stenting reduces the combination of death, MI and urgent revascularization as compared with strategy of medical therapy alone," Mavromatis says. "This benefit was specifically due to the reduced need of urgent due to , a dramatic event for our patients."

Some cardiologists have criticized the FAME 2 study, noting that the benefits of stenting didn't come in terms of reducing "hard events" (deaths and heart attacks).

"It is important to recognize that less symptoms of angina and less chance of hospitalization are tremendous benefits that our patients really appreciate," Mavromatis says. "I think FFR will play a bigger role in evaluating and treating coronary artery disease, as it can direct stenting much more precisely than angiography toward clinically important coronary artery disease, improving patients' outcomes and saving money."

The FFR procedure costs several hundred dollars but that is significantly less than the cost of implanting a coronary stent. Habib Samady, MD, director of interventional cardiology at Emory, has also been an advocate for the use of FFR to select who would benefit from a coronary stent. He wrote an article describing its uses in 2009:

We have been using and advocating FFR since pressure guidewire technology first came to the U.S. in 1998. At Emory, we are sometimes asked to reevaluate patients who have been slated for CABG surgery at another hospital where recommendations are made based on angiography alone. When we evaluate these cases using FFR, we are sometimes able to recommend courses of treatment that involve fewer stents or even medical therapy. Occasionally, based on FFR data, we send our patients for an endoscopic or "minimally invasive" bypass and stent the remaining narrowings.

In addition, FFR has helped reduce the number of multi-vessel PCIs performed. Patients who might have received stents in three vessels after angiography alone would likely receive stents in only one or two vessels after FFR-guided analysis. Among patients with single-vessel disease, FFR often has allowed us to recommend medical treatment in lieu of stenting. Implanting fewer stents also means using less contrast agent and fewer materials, which lowers the expenses involved in treatment.

A large, multi-center study called ISCHEMIA is starting that will address the coronary stent vs medical therapy issue in a more definitive way. Both Emory and the Atlanta VA Medical Center are participating. "This is a very important next step in understanding the benefits of invasive therapy of stable ischemic heart disease," Mavromatis says.

Explore further: Early use of stents better than medical therapy alone for certain patients

More information: doi: 10.1056%2FNEJMoa1205361

Related Stories

Early use of stents better than medical therapy alone for certain patients

August 28, 2012
For patients with stable coronary artery disease who have at least one narrowed blood vessel that compromises flow to the heart, medical therapy alone leads to a significantly higher risk of hospitalization and the urgent ...

PCI guided by fractional flow reserve versus medical therapy alone in stable coronary disease

August 28, 2012
Patients with stable coronary artery disease (CAD) had a lower need for urgent revascularisation when receiving fractional flow reserve (FFR)-guided PCI plus the best available medical therapy (MT) than when receiving MT ...

Improved technology may obviate need for drug when assessing patients for a coronary stent

December 7, 2011
A new method for measuring narrowing in the arteries of the heart may allow patients to be assessed for a stent without having to take a drug with unpleasant side effects.

Recommended for you

Some cancer therapies may provide a new way to treat high blood pressure

November 20, 2017
Drugs designed to halt cancer growth may offer a new way to control high blood pressure (hypertension), say Georgetown University Medical Center investigators. The finding could offer a real advance in hypertension treatment ...

Could this protein protect people against coronary artery disease?

November 17, 2017
The buildup of plaque in the heart's arteries is an unfortunate part of aging. But by studying the genetic makeup of people who maintain clear arteries into old age, researchers led by UNC's Jonathan Schisler, PhD, have identified ...

Raising 'good' cholesterol fails to protect against heart disease

November 16, 2017
Raising so-called 'good' cholesterol by blocking a key protein involved in its metabolism does not protect against heart disease or stroke, according to a large genetic study of 150,000 Chinese adults published in the journal ...

Popular e-cigarette liquid flavorings may change, damage heart muscle cells

November 16, 2017
Chemicals used to make some popular e-cigarette liquid flavorings—including cinnamon, clove, citrus and floral—may cause changes or damage to heart muscle cells, new research indicates.

New model estimates odds of events that trigger sudden cardiac death

November 16, 2017
A new computational model of heart tissue allows researchers to estimate the probability of rare heartbeat irregularities that can cause sudden cardiac death. The model, developed by Mark Walker and colleagues from Johns ...

Possible use for botulinum toxin to treat atrial fibrillation

November 16, 2017
From temporarily softening wrinkles to easing migraines, botulinum toxin has become a versatile medical remedy because of its ability to block nerve signals that can become bothersome or risky.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.