Are Stents Overused For Treating Chronic Heart Conditions?

Questions have been raised recently on whether cardiac stents are being overused as an initial management strategy to treat chronic heart disease, specifically coronary artery disease. Are doctors putting their stable patients’ lives at risk when they place a cardiac stent to treat their condition when conservative management is just as effective?

What is a Cardiac Stent?

Also called coronary stents, these tubes are usually made of metal, although some are made of fabric. Drug-eluting stents, on the other hand, are coated with some medicine that is slowly released into the coronary artery to prevent it from being blocked again.

Stents are used as scaffolds to hold the inner walls of a coronary artery open.  They are placed into the arteries during a procedure called percutaneous coronary intervention (PCI) or angioplasty, which is similar to a coronary angiogram. PCI is done to treat patients with coronary heart disease whose blood vessels to the heart muscles are blocked, to prevent these muscles from dying. 

Although stents open blocked arteries and improve blood flow in the heart muscles, this does not cure coronary heart disease. Patients need to continue taking certain medications and to improve on some lifestyle factors to reduce their risk of suffering from a heart attack, a complication of the disease.

Risks of Stent Placement

The placement of a cardiac stent is a minimally invasive procedure that does not involve major incisions and only requires local anesthesia with mild sedation. Although it is generally considered a safe procedure, it is not entirely risk-free.

Immediate complications include bleeding, irregular heartbeats, damage to the coronary artery, infection, allergic reaction to the dye used during the procedure, and kidney damage caused by the dye. Aside from these, delayed complicationscan also occur.

Manipulation of the artery can cause injury to the inner walls of the blood vessel, leading to subsequent scar formation. This can likewise cause re-narrowing of the artery, which may require reinsertion of another stent or coronary bypass surgery. These events could lead to a heart attack or stroke if not immediately corrected.

New technologies in the development of stents have led to the creation of the drug-eluting stent, which are designed to prevent blood clot formation inside the stent. Because of its effectiveness and safety, the use of this type of stents has greatly increased in recent years.

Read More: Stent Or Bypass: Which Is Better For Treating Heart Disease In Diabetics?

Still, more stent designs are currently under development, including stents that can be absorbed by the body after they have done their job, and stainless steel stents coated with platinum.

Should Stents Be Used In Chronic But Stable Heart Disease?

Coronary heart disease develops when excess cholesterol and calcium build up inside the walls of the heart arteries and result in their narrowing, leading to reduced blood flow to the heart muscles. This process usually occurs over a long time, sometimes not being felt by an individual until he suffers from chest pains or a heart attack.

Coronary artery disease is initially treated by making significant lifestyle changes, including eating a heart-healthy diet, stopping smoking, and increasing physical activity. Doctors also prescribe medicines that help bring down high cholesterol, control high blood sugar, and reduce high blood pressure. Many patients are able to live in a stable condition for many years, as long as they are able to control their weight and manage other risk factors using these conservative treatments.

Indication for Use

Severe narrowing of the coronary arteries or formation of blood clots that compromises oxygen supply to the heart muscles are the common reasons why doctors use cardiac stents. These events are usually associated with heart attacks or episodes of angina. Success rate is about 95%, depending on the degree of narrowing of the artery. In some patients, the coronary artery remains narrowed, and in about one percent, an immediate cardiac bypass surgery may be needed.

Stents therefore offer an easy, safe, and effective way of treating clogged heart arteries that they have become quite popular in use. 

Stents bring good business, too, since they generate billions of dollars in sales annually for their manufacturers and thousands of dollars for the cardiac specialists who implant them.

The Controversy

The recent controversy however started when reports showed that stent placement is one of the most overused medical procedures that are often performed even when not necessary. Some scandals also cropped up when deaths were linked to the rising number of patients undergoing the procedure.

Cardiology experts began questioning whether the increasing use of stents could improve the outcome of patients with chronic but stable coronary heart disease, or if it would instead endanger many patients’ lives. Even drug-coated stents, which were believed to reduce the incidence of re-blockage several months after placement have been linked to complications and they did not guarantee long-term survival.

Read More: Abbott Absorbable Heart Stent Proven Safe and Effective

Patients with normal heart function in spite of their weak arteries are considered to have a stable condition. Optimal medical therapy consists of antiplatelet medications, which reduce the risk of blood clot formation, beta-blockers, and nitrates to reduce high blood pressure, and anti-cholesterol drugs. Results show that although the addition of percutaneous coronary intervention to optimal medical therapy reduced angina, it did not reduce death rate, heart attack risk, and hospitalization in the long term.

Patients who have coronary heart disease must discuss their treatment options with their cardiologists to learn more about their advantages and risks. It is important to first determine whether aggressive treatment will give better results than conservative therapy or if there are no significant differences in their outcomes.