Medications alone work as well as surgery for some heart disease patients
Patients with stable ischemic heart disease can avoid stents or bypass surgery
In their heyday, stents and bypass surgery were the go-to treatment for patients newly diagnosed with heart disease. That began to change about a decade ago, after new data emerged suggesting these procedures were no better than treatment with medical therapy alone for patients whose heart-related symptoms aren’t considered an emergency. Now a large study has tipped the scales further, reporting that statins, aspirin and other medications together protect these patients just as well as stents or bypass surgery against heart attacks and death.
The key to managing these patients, who have stable ischemic heart disease, “is medicines, medicines, medicines,” says Michael Gavin, a cardiologist at Beth Israel Deaconess Medical Center in Boston who was not involved in the study. “That’s what’s going to stop you from having a heart attack.”
Going the medical therapy route does require that patients are committed to that route. That means seeing the doctor regularly, keeping up with medications and exercise and eating a healthy diet. Medical therapy “gives a good prognosis,” says preventive cardiologist Gina Lundberg of Emory University School of Medicine, who was not involved in the study. But “you can’t say ‘I don’t want the stent,’ and then not do all those things, and get a good result.”
The federally-funded study, called ISCHEMIA, is the largest clinical trial to examine whether medical therapy alone, or along with stents or bypass surgery, reduces death or heart attacks in patients who have heart disease primarily due to plaque-containing, narrowed coronary arteries, but who have manageable pain or other symptoms. The participants in the invasive procedure group had a device threaded through the arteries, followed by placement of a stent to keep an artery open or else bypass surgery to divert blood flow around a blockage. The procedures come with risks such as bleeding or the formation of blood clots that can block an artery again.