Drugs as Good as Stents for Most Heart Patients

Drug therapy appears to be as effective as arterial stents in relieving chest pain in people with chronic heart disease, according to a major study that compared the two treatments in 2,287 patients with stable coronary disease.

Researchers who analyzed results of the seven-year COURAGE trial found no difference after three years in the health status of patients who had only medications (a mix of aspirin and drugs that lower blood pressure and cholesterol and expand the blood vessels), compared with patients treated with stents and medications. One exception: People with severe chest pain fared better with stents.

“The study should be viewed as good news for patients,” says study leader William Weintraub, M.D., chief of cardiology at Christiana Care Health System in Newark, Del. “Now patients don’t have to rush out and get an artery-opening procedure.”

Stents are mesh tubes that hold narrowed or blocked arteries open. They are inserted via angioplasty, a procedure in which a tiny balloon is inserted into the diseased artery and inflated to open the vessel. More than 1 million angioplasties are performed each year in the United States, making the procedure the top treatment for people who are having heart attacks or are hospitalized for worsening heart conditions.

The COURAGE trial was funded by the U.S. Department of Veteran Affairs, the Medical Research Council of Canada, and several drug companies; results were published in the New England Journal of Medicine on Aug. 14.

Steven Nissen, M.D., chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, says that the results show that doctors can now counsel their patients in stable condition that they have two reasonable options for treatment.