However, there are cases in which the decision has to be made by the doctor, he said. People who are unable or unwilling to take the clot-preventing medications, such as aspirin or Plavix, would not be suitable for stenting and "should be strongly encouraged to have surgery," Hillis said. "Then there are patients who for some reason have another disease entity that makes surgery a risk -- a bad lung condition, for example." Such conditions are found in 5 to 10 percent of cases, he said.
But generally, Hillis said, many physicians will let the patient choose. "I haven't taken a poll, but I think most would sit down and present the options to the patients."
Another report in the same issue of the journal affirmed the finding of a major study done two years ago that drug therapy was as effective alone as with stenting for people treated for heart attacks days or weeks after they occurred.
The new study, by physicians at Duke University, found that stenting did produce some temporary improvement in the quality of life but that the long-term benefits did not differ from those of drug treatment alone.
The Cleveland Clinic has more on coronary artery disease.
SOURCES: David R. Holmes Jr., M.D., professor of medicine, Mayo Clinic Graduate School of Medicine, Rochester, Minn.; L. Davis Hillis, M.D., chairman, department of medicine, University of Texas Health Science Center, San Antonio, Texas; March 5, 2009, New England Journal of Medicine