In the largest such analysis of its kind, the Duke researchers said their findings have important economic and clinical implications for physicians who are deciding whether their heart patients should receive coronary artery bypass surgery, or less-invasive angioplasty, which includes the placement of a stent.
Stents, which were introduced in the U.S. in 1994, are tiny mesh tubes that are inserted at the site of a blockage in a coronary artery that has been opened during balloon angioplasty. The procedure seeks to prevent the artery from becoming blocked again, a process known as restenosis. These blockages, caused by atherosclerotic plaque, can starve the heart of oxygen-rich blood and lead to a heart attack.
Duke cardiologist David Kandzari, M.D., who presented the results of the Duke analysis Nov.7, 2004, at the American Heart Association's annual scientific sessions in New Orleans, said the findings on mortality rates should also be expected to hold true for the latest generation of drug-eluting stents. These stents, which were introduced in 2003, are coated with a drug that keeps blood clots from forming inside them.
"We have found in our long-term analysis that stents do provide a significant early and sustained reduction in the need for subsequent procedures to re-open the treated artery," Kandzari said. "However, we also found that stents do not have any influence on long-term survival.
"Since earlier studies have shown that new drug-eluting stents can lessen the incidence of restenosis, we would expect the need for repeat procedures to decline even more as these stents become more widely used," Kandzari continued. "While earlier trials of drug-elu
Contact: Richard Merritt
Duke University Medical Center