Should More Heart Patients Get Stents? Study Says Yes


"Fractional flow reserve (FFR) is a powerful, invasive tool that can pick out blockages that, at least at the time at which they are being studied, are sufficiently severe as to be able to prevent a safe and healthy increase of blood flow to the heart and can distinguish them from blockages that are not," said Dr. Brian O'Murchu, associate professor of medicine and associate director of the cardiac catheterization laboratory at Temple University in Philadelphia. "In this way, it gives much the same information as is provided by stress tests that include imaging of the heart."

"Recent pressure based on the COURAGE trial to reduce overall stent usage has made an early revascularization strategy less clear," said Dr. George W. Vetrovec, a professor of medicine in cardiology at Virginia Commonwealth University. "FAME II provides, I believe, an important counter argument in patient management for stable but symptomatic coronary disease."

Yet, some doctors remain cautious about these results.

One of these physicians is Dr. Harlan Krumholz, professor of medicine and investigative medicine at Yale University. Krumholz said that the new study falls short of proving that stents prevent heart attack and death.

"[T]he rates of death and the rates of [heart attack] were similar in the two groups," Krumholz said.

Others agreed. "I do not think that this trial should change practice," said Dr. Raymond Gibbons, professor of medicine at the Mayo Clinic. "Try medical therapy first. If your symptoms don't improve, then discuss the risk and benefits of stents with your physicians. Realize that stents do not reduce the rate of heart attack and death."

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