Stents Have No Value for Late Heart Attack Treatment
New results from the second round of the Occluded Artery Trial (OAT) show that stents have no value for late heart attack treatment.
Stents are devices used to open clogged heart arteries and restore blood flow.
Though immediate treatment for heart attack is recommended, approximately 1/3 of patients receive late diagnosis of heart attack. Heart stents are placed during cardiac catheterization to open blocked arteries hours or days after heart attacks happen, believed by physicians to be the best treatment,
The study compared patients who received heart stents combined with drugs with those who received drug treatment only when diagnosed days or weeks after the heart attack occurred. The study found there is no difference in patient outcomes between the two treatments.
The newer study supports research results published two years ago showing that patients treated with drugs alone for late treatment of heart attacks spend less in healthcare dollars and have the same quality of life as patients who receive stents.
Daniel Mark, MD, from the Outcomes Research Group at the Duke Clinical Research Institute authored the study, published Feb. 19 in the New England Journal of Medicine. Dr. Mark says, "The finding is just one more reason to question the use of routine stenting in late-treatment patients when cheaper, less invasive options are just as effective."
In the original OAT study that included 2,166 patients, the researchers found no difference in the effect of medical treatment plus placing heart stents or performing percutaneous coronary intervention (PCI) and just using medications days or weeks after a heart attack occurs.
The new study examined quality of life of the patients, building on the original OAT study. The results showed that heart stents and PCI did not have any lasting effect, and only modest benefit for reducing chest pain and heart function in heart attack patients who received delayed treatment.
Duke researchers used a standardized tool to measure heart function, pain, physical ability, social function and vitality among 951 patients enrolled in the original OAT study. All had received medication, and half had also received PCI, experiencing a heart attack anywhere from 3 to 28 days before enrollment.
By the end of the study, the researchers found no difference in all measurements of quality of life among the patients treated with drugs, and those treated with PCI after their heart attack.
The PCI group had 1.2 more days of hospitalization, and two-year cost was $7000 higher than heart attack patients given optimal medical therapy alone versus heart stents and medication.
"What we have here is one of those cases where less is more. While it may seem that going an extra step in opening up clogged arteries even days after a heart attack, we know that clinically, it doesn't seem to offer the advantages we expected, "says Mark.
The findings are important for the delivery of high quality medical care at almost half the price. The authors say the cost and long–term outcome of placing a heart stent more than one day after a patient experiences a heart attack is of no value.
Duke Medicine News and Communications