 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Summaries for Patients are a service provided by Annals to help patients better understand the complicated and often mystifying language of modern medicine.
SUMMARIES FOR PATIENTS
Benefits of Coronary Stents
20 May 2003 | Volume 138 Issue 10 | Page I-15
Summaries for Patients are presented for informational purposes only. These summaries are not a substitute for advice from your own medical provider. If you have questions about this material, or need medical advice about your own health or situation, please contact your physician. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the American College of Physicians.
The summary below is from the full report titled "Evidence for Use of Coronary Stents. A Hierarchical Bayesian Meta-Analysis." It is in the 20 May 2003 issue of Annals of Internal Medicine (volume 138, pages 777-786). The authors are J.M. Brophy, P. Belisle, and L. Joseph.
What is the problem and what is known about it so far?
Blockage of the arteries that supply blood to the heart (coronary heart disease or CHD) causes more deaths in the United States than any other condition. Many people with CHD undergo procedures, such as percutaneous transluminal coronary angioplasty (PTCA), to unblock clogged or narrowed arteries. PTCAs relieve chest pain and may improve survival in some patients with CHD. For standard PTCA, a physician threads a thin tube (catheter) through blood vessels and uses a balloon attached to the tip of the catheter to widen the arteries that have been narrowed by disease. For PTCAs with stents, a physician inserts a small metal or plastic tube into a narrowed artery and leaves it there to help keep the artery open. Patients having PTCAs often get stents, even though they cost more than standard PTCAs. A summary of the studies that have compared the two procedures would help physicians and patients understand the benefits of each.
Why did the researchers do this particular study?
To summarize results of trials that compared coronary stents to PTCA.
Who was studied?
The trials included 9918 patients with CHD.
How was the study done?
The researchers searched the medical literature to find randomized trials that compared coronary stents with PTCA. They found 29 trials that 1) included patients with CHD but no acute heart attack and 2) followed patients for at least 6 months after their procedure. In many trials, patients who had standard PTCA could have a stent if they developed complications or if the PTCA was unsuccessful. This "bailout" strategy was called provisional stenting. The researchers compared outcomes between groups by using special methods of analysis (meta-analysis).
What did the researchers find?
The researchers found no differences in numbers of heart attacks, coronary artery bypass surgeries, or deaths between groups. Patients who were given stents had lower rates of restenosis (reclosing of the artery) and fewer repeated procedures to open up coronary arteries than did patients who underwent standard PTCA. Routine stents compared with provisional stents reduced the need for repeated coronary artery procedures by about 5 per 100 patients treated.
What were the limitations of the study?
Costs were not studied. None of the trials tested new stents that are coated with drugs (drug-eluting stents); these may help prevent reclogging.
What are the implications of the study?
Compared with standard PTCAs, stents more often prevent restenosis and avoid the need for repeated procedures; however, they do not improve survival or prevent heart attacks. Using stents routinely rather than provisionally has only modest benefits.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  D. G. Katritsis and B. Meier Percutaneous Coronary Intervention for Stable Coronary Artery Disease J. Am. Coll. Cardiol., September 9, 2008; 52(11): 889 - 893. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Schomig, J. Mehilli, A. de Waha, M. Seyfarth, J. Pache, and A. Kastrati A Meta-Analysis of 17 Randomized Trials of a Percutaneous Coronary Intervention-Based Strategy in Patients With Stable Coronary Artery Disease J. Am. Coll. Cardiol., September 9, 2008; 52(11): 894 - 904. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Hlatky and D. M. Bravata Stents or Surgery?: New Data on the Comparative Outcomes of Percutaneous Coronary Intervention and Coronary Artery Bypass Graft Surgery Circulation, July 22, 2008; 118(4): 325 - 327. [Full Text] [PDF]
|
|
|
|
 |
|
 D. R. Holmes Jr, B. J. Gersh, P. Whitlow, S. B. King III, and J. T. Dove Percutaneous Coronary Intervention for Chronic Stable Angina: A Reassessment J. Am. Coll. Cardiol. Intv., February 1, 2008; 1(1): 34 - 43. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. M. Bravata, A. L. Gienger, K. M. McDonald, V. Sundaram, M. V. Perez, R. Varghese, J. R. Kapoor, R. Ardehali, D. K. Owens, and M. A. Hlatky Systematic Review: The Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Graft Surgery Ann Intern Med, November 20, 2007; 147(10): 703 - 716. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Windecker and B. Meier Late Coronary Stent Thrombosis Circulation, October 23, 2007; 116(17): 1952 - 1965. [Full Text] [PDF]
|
|
|
|
 |
|
 R. G. Maki, J. K. Wathen, S. R. Patel, D. A. Priebat, S. H. Okuno, B. Samuels, M. Fanucchi, D. C. Harmon, S. M. Schuetze, D. Reinke, et al. Randomized Phase II Study of Gemcitabine and Docetaxel Compared With Gemcitabine Alone in Patients With Metastatic Soft Tissue Sarcomas: Results of Sarcoma Alliance for Research Through Collaboration Study 002 J. Clin. Oncol., July 1, 2007; 25(19): 2755 - 2763. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The BARI Investigators The Final 10-Year Follow-Up Results From the BARI Randomized Trial J. Am. Coll. Cardiol., April 17, 2007; 49(15): 1600 - 1606. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Ligthart, F. Vlemmix, N. Dendukuri, and J. M. Brophy The cost-effectiveness of drug-eluting stents: a systematic review Can. Med. Assoc. J., January 16, 2007; 176(2): 199 - 205. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. K. Smith, R. M. Califf, R. H. Tuttle, L. K. Shaw, K. L. Lee, E. R. Delong, R. E. Lilly, M. H. Sketch Jr, E. D. Peterson, and R. H. Jones Selection of surgical or percutaneous coronary intervention provides differential longevity benefit. Ann. Thorac. Surg., October 1, 2006; 82(4): 1420 - 1429. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Dewey, F. Teige, D. Schnapauff, M. Laule, A. C. Borges, K.-D. Wernecke, T. Schink, G. Baumann, W. Rutsch, P. Rogalla, et al. Noninvasive detection of coronary artery stenoses with multislice computed tomography or magnetic resonance imaging. Ann Intern Med, September 19, 2006; 145(6): 407 - 415. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. B. Barner Status of percutaneous coronary intervention and coronary artery bypass. Eur. J. Cardiothorac. Surg., September 1, 2006; 30(3): 419 - 424. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Fajadet, W. Wijns, G.-J. Laarman, K.-H. Kuck, J. Ormiston, T. Munzel, J. J. Popma, P. J. Fitzgerald, R. Bonan, R. E. Kuntz, et al. Randomized, Double-Blind, Multicenter Study of the Endeavor Zotarolimus-Eluting Phosphorylcholine-Encapsulated Stent for Treatment of Native Coronary Artery Lesions: Clinical and Angiographic Results of the ENDEAVOR II Trial Circulation, August 22, 2006; 114(8): 798 - 806. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Authors/Task Force Members, K. Fox, M. A. A. Garcia, D. Ardissino, P. Buszman, P. G. Camici, F. Crea, C. Daly, G. De Backer, P. Hjemdahl, et al. Guidelines on the management of stable angina pectoris: executive summary: The Task Force on the Management of Stable Angina Pectoris of the European Society of Cardiology Eur. Heart J., June 1, 2006; 27(11): 1341 - 1381. [Full Text] [PDF]
|
|
|
|
|
|
A. Kastrati, A. Dibra, J. Mehilli, S. Mayer, S. Pinieck, J. Pache, J. Dirschinger, and A. Schomig Predictive Factors of Restenosis After Coronary Implantation of Sirolimus- or Paclitaxel-Eluting Stents Circulation, May 16, 2006; 113(19): 2293 - 2300. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Seabra-Gomes Percutaneous coronary interventions with drug eluting stents for diabetic patients. Heart, March 1, 2006; 92(3): 410 - 419. [Full Text] [PDF]
|
|
|
|
 |
|
 P. W. Serruys, M. J.B. Kutryk, and A. T.L. Ong Coronary-Artery Stents N. Engl. J. Med., February 2, 2006; 354(5): 483 - 495. [Full Text] [PDF]
|
|
|
|
|
|
J. Mehilli, A. Dibra, A. Kastrati, J. Pache, J. Dirschinger, A. Schomig, and for the Intracoronary Drug-Eluting Stenting to Abr Randomized trial of paclitaxel- and sirolimus-eluting stents in small coronary vessels Eur. Heart J., February 1, 2006; 27(3): 260 - 266. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Windecker, A. Remondino, F. R. Eberli, P. Juni, L. Raber, P. Wenaweser, M. Togni, M. Billinger, D. Tuller, C. Seiler, et al. Sirolimus-Eluting and Paclitaxel-Eluting Stents for Coronary Revascularization N. Engl. J. Med., August 18, 2005; 353(7): 653 - 662. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. P. A. Ioannidis Contradicted and Initially Stronger Effects in Highly Cited Clinical Research JAMA, July 13, 2005; 294(2): 218 - 228. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. G. Katritsis and J. P.A. Ioannidis Percutaneous Coronary Intervention Versus Conservative Therapy in Nonacute Coronary Artery Disease: A Meta-Analysis Circulation, June 7, 2005; 111(22): 2906 - 2912. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Agostoni, G. G.L. Biondi-Zoccai, G. L. Gasparini, M. Anselmi, G. Morando, M. Turri, A. Abbate, E. P. McFadden, C. Vassanelli, P. Zardini, et al. Is bare-metal stenting superior to balloon angioplasty for small vessel coronary artery disease? Evidence from a meta-analysis of randomized trials Eur. Heart J., May 1, 2005; 26(9): 881 - 889. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al. Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology Eur. Heart J., April 2, 2005; 26(8): 804 - 847. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Brophy The dollars and sense of drug-eluting stents Can. Med. Assoc. J., February 1, 2005; 172(3): 361 - 362. [Full Text] [PDF]
|
|
|
|
|
|
W. E. Boden Surgery, angioplasty, or medical therapy for symptomatic multivessel coronary artery disease: Is there an indisputable "winning strategy" from evidence-based clinical trials? J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1752 - 1754. [Full Text] [PDF]
|
|
|
|
|
|
D. R. Holmes Jr, M. B. Leon, J. W. Moses, J. J. Popma, D. Cutlip, P. J. Fitzgerald, C. Brown, T. Fischell, S. C. Wong, M. Midei, et al. Analysis of 1-Year Clinical Outcomes in the SIRIUS Trial: A Randomized Trial of a Sirolimus-Eluting Stent Versus a Standard Stent in Patients at High Risk for Coronary Restenosis Circulation, February 10, 2004; 109(5): 634 - 640. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. Massel Evidence for Use of Coronary Stents Ann Intern Med, January 20, 2004; 140(2): W-4 - W-4. [Full Text] [PDF]
|
|
|
|
|
|
A. J Nordmann, P. Hengstler, B. M Leimenstoll, T. Harr, J. Young, and H. C Bucher Clinical outcomes of stents versus balloon angioplasty in non-acute coronary artery disease: A meta-analysis of randomized controlled trials Eur. Heart J., January 1, 2004; 25(1): 69 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. Malik JournalScan Heart, August 1, 2003; 89(8): 959 - 960. [Full Text] [PDF]
|
|
|
|
 |
|
 Are the Benefits of Coronary Stenting Overstated? Journal Watch Cardiology, July 25, 2003; 2003(725): 2 - 2. [Full Text]
|
|
|
|
 |
|
 Coronary Stenting: Better, but How Much Better? Journal Watch (General), June 13, 2003; 2003(613): 3 - 3. [Full Text]
|
|
|
|
|
|
S. B. King III Why Have Stents Replaced Balloons? Underwhelming Evidence Ann Intern Med, May 20, 2003; 138(10): 842 - 843. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Article
