Stents need not be ordered stat

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A recent review published in the Archives of Internal Medicine finds that, compared to standard drug therapy, inserting a stent to repair a narrowed artery has no benefit in patients with stable coronary artery disease (CAD). Stable CAD, or stable angina, refers to chest pain or discomfort that occurs following exercise or stress. Angina has been thought to indicate that medical therapy alone is not enough, so doctors will often perform the surgical technique of stent insertions, or percutaneous coronary interventions (PCI), on these patients. PCI consists of inserting a mesh tube into a narrowed artery in order to expand it and improve blood flow.

For the latest study, researchers from Stony Brook University analyzed randomized trials that included over 7,000 patients overall. Half underwent a PCI and the other half received drug therapy, which consisted of treatment with beta blockers, ACE inhibitors, statins, and daily aspirin. After four years of follow-up, death rates were nearly the same in both groups: 8.9 percent among those receiving PCI and 9.1 percent for those treated with drugs alone. Rates for nonfatal heart attacks were also not statistically different between the two cohorts.

The latest results are important, since over a million PCI surgeries are performed in the U.S. annually, costing between $30,000 and $50,000 per procedure. However, since standard medical care seems to be equally effective for the treatment of stable CAD, there may be no need to rush to surgery. In fact, previous studies have arrived at the same conclusion. So why, then, are doctors still performing PCIs at such a high rate? According to lead investigator Dr. David L. Brown, the reason may be financial.

In many hospitals, the cardiac service line generates 40 percent of the total hospital revenue, so there s incredible pressure to do more procedures, he says.

If such speculation were true, comments ACSH's Dr. Gilbert Ross, that would be really sad.

Perhaps doctors should exercise a little more forethought when deciding who actually needs to undergo a PCI, says ACSH's Dr. Ruth Kava. By doing so, we could be saving an awful lot of money without compromising anyone s health.