Overkill by Paul A. Offit M.D

Author:Paul A. Offit, M.D.
Language: eng
Format: epub
Publisher: HarperCollins
Published: 2020-04-14T00:00:00+00:00

Heart Stents Don’t Prolong Lives

In 2006, researchers from New York University School of Medicine, in collaboration with researchers from around the world, randomly assigned 2,200 patients to receive bare metal stents plus medical therapy or medical therapy alone. They found that stents “did not reduce the occurrence of death, myocardial infarctions, or heart failure.”15

In 2007, researchers from fifty U.S. and Canadian medical centers randomly assigned 2,300 patients to receive stents plus medical therapy or medical therapy alone, finding that stents “did not reduce the risk of death, myocardial infarctions, or other major cardiovascular events.” At the time of this study, more than one million stents had been placed in the United States.16 A follow-up of this study showed that while those in the stent group were more likely to be free of angina three months after surgery, three years later the benefit disappeared.17

In 2009, researchers from Tufts Medical Center, in Boston, reviewed twenty years of studies that initially evaluated balloon dilatation and later bare metal and drug-eluting stents to see if surgery was better than medical therapy alone. It wasn’t.18

A casual observer at this point would have reasonably assumed that the twenty-year review would have put an end to stenting. It didn’t.

In 2014, researchers from the State University of New York Stony Brook School of Medicine reviewed yet another five studies, which involved 5,300 more patients. They found that stents plus medical therapy were “not associated with a reduction in death, non-fatal myocardial infarction . . . or angina compared with medical therapy alone.”19

Similar to the 2009 review, the 2014 review also didn’t eliminate the medical profession’s desire to put stents into patients with angina. There would be one more study—a study that should have ended all studies. For years, cardiologists had argued that while stents might not prolong lives or lessen the risk of heart attack, they did seem to lessen the frequency of angina, even if only for a short while and even if only in a few studies. The problem with angina, however, is that it’s subjective. People perceive pain differently. Those who opposed stenting argued that following a procedure that is supposed to reduce pain, patients would be more likely to believe that they were experiencing less pain—even if they weren’t. In other words, the placebo effect. But how could cardiologists perform a placebo-controlled trial of stenting? As it turned out, Rasha Al-Lamee and colleagues at Imperial College London found a way. In 2017, they published the results of their groundbreaking and controversial study.

To control for the placebo effect, the researchers in the United Kingdom randomly assigned patients who had single-vessel coronary artery disease with at least 70 percent blockage to receive a stent or to undergo a procedure where a catheter was threaded up into a coronary artery, but no stent was placed. None of the patients knew whether they had actually received a stent. Patients were then tested on a treadmill to see how long they could exercise before experiencing pain. Researchers found that both groups had improved exercise tolerance, even those with the fake stent procedure.

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