Heart Stents No Better Than Drugs for Chest Pain Over Time

There are major issues that need to be remembered when generalising the results of COURAGE trial 1.Patients with high grade anginal symptoms and strongly positive stress tests were excluded. Thus the COURAGE data applies to only the low risk subset of chronic stable angina 2. Optimum medical treatment with excellent compliance was employed in the medical treatment arm but sub-optimal treatment in...

The general public hears the bullet that stents are no better than medications, but the reality that this trial (COURAGE trial) had major flaws, the main being that only 10% of the patients screened participated in the trial. 90% were excluded. Thus, the patients enrolled were not necessarily the typical patients. Also, very few of the new, drug-eluting stents were used. That being said, the initial...

Because equivalent results were shown, there will be no change in stent placement volumes.

This article could easily be spun as a victory for stent efficacy.

the impact will be small. The study is not a big surprise. No cardiologist thought he is saving lives stenting arteries in stable patients. The study required every one to get an angiogram if they had an abnormal stress test to qualify. We probably already not refer every abnormal test for cath using clinical judgement and severity of the abnormality. It is somewhat of a surprise that stents...

Once again, we see that medications in most cases are as effective as stenting.  This is old news dating back to the CASS trial in the 1970's and 1980's. Every time we come up with a slick new device we test it against the standard of care and it comes up more expensive and no more effective.  First it was CABG, then PTCA (angioplasty) then stenting, then DES.  Suprisingly, it gets...

Most hospitals are financially built on their heart programs. The "agressive" medical arm is conservative by our standards yet as good as stents at far less cost. If this was truly pursued by large companies with TPA insurance plans, their overall cost would drop with large savings in healthcare costs. They will need to eliminate disincentives (copays) to proper prescribing, replacing them with...

As a sales executive in the cardiac surgery market for many years, I have been involved with many aspects of this industry as well as having met many cardiac surgeons and seen numerous coronary surgeries. Overall, the success rate with stents is poor vs coronary bypass and certain follow up medications. The ratio of success vs failure is impressive when studying the success of stents.   Edward...

You can only open up an artery so far. Whether you achieve this with drugs, or a mechanical device doesn't seem to matter as long as the blood gets flowing again.

To stent or not to stent: presence and degree of coronary artery disease, effectiveness of medical therapy and significance of symptoms and, therefore, indications for coronary stents placement are determined by very same physicians who place stents. Stents are reimbursed 10-20 times better than medical management.

This study pretty convincingly shows that there is only a short term symptom and quality of life improvement associated with coronary stenting, as compared to good quality pharmacological treatment. This will decrease the pressure for aggressive revascularization of any and all coronary lesions (which has been pushed by many interventionalists). If the results are accepted by the health...