November 19, 2019
The findings of a large federal study on the efficacy of cardiac bypass surgeries and stents—led by NYU Langone Health with collaboration from 15 other leading U.S. and Canadian hospitals—call into question the medical care provided to tens of thousands of heart disease patients with blocked coronary arteries, scientists reported at a meeting of the American Heart Association on November 16.
The purpose of the ISCHEMIA trial was to determine the best management strategy for higher-risk patients with stable ischemic heart disease (also known as hardening of the arteries). The study involved over 5,000 participants.
Among the researchers’ key findings: Drug therapy, alone, may save lives just as effectively as bypass or stenting procedures. Stenting and bypass procedures, however, did help some patients with intractable chest pain, called angina.
“You would think that if you fix the blockage the patient will feel better or do better,” Dr. Alice Jacobs, director of Cath Lab and Interventional Cardiology at Boston University, told The New York Times after the results were released.. The study, she added, “certainly will challenge our clinical thinking.”
This is far from the first study to suggest that stents and bypass are overused. But, the Times reports, previous results have not deterred doctors, who have called earlier research on the subject inconclusive and the design of the trials flawed.
Previous studies did not adequately control for risk factors, like LDL cholesterol, that might have affected outcomes, Dr. Elliott Antman, a senior physician at Brigham and Women’s Hospital in Boston told the news outlet in an interview. Nor did those trials include today’s improved stents, which secrete drugs intended to prevent opened arteries from closing again.
With its size and rigorous design, the new study, called Ischemia, was intended to settle questions about the benefits of stents and bypass.
However, there may be a catch: The conventional wisdom among cardiologists is that the sort of medical therapy that patients got in Ischemia is just not feasible in the real world, said Dr. William E. Boden, scientific director of the Clinical Trials Network at VA Boston Healthcare System, who was a member of the study’s leadership committee.
But getting a stent does not obviate the need for medical therapy, Dr. Boden told the Times. Since patients with stents need an additional anti-clotting drug, they actually wind up taking more medication than patients who are treated with drugs alone.
“We have to finally get past the whining about how hard optimal medical therapy is and begin in earnest to educate our patients as to what works and is effective and what isn’t,” Dr. Boden said.
Research source: @nytimes