Heart Stents: Are They Really Necessary?

A heart, or coronary, stent is a small mesh tube inserted into narrow or weak arteries. The stent supports the inner wall of the weakened artery, or props open the artery walls in danger of collapsing. Inserting a stent—in a procedure called percutaneous coronary intervention (PCI) or angioplasty—is a common treatment used to prevent heart attack and relieve chest pain.

Stents help improve blood flow. If a patient is at risk for an imminent heart attack, inserting a stent can save his life. Doctors also recommend a PCI in the case of angina—severe chest pain. A new study, published in the Lancet last November, questions whether PCI actually helps relieve chest pain.

What is angina?

Angina means severe pain in the chest, often radiating to the neck, shoulders, and arms. There are several different types of angina, the two most common being chronic stable angina and unstable angina.

Stable angina happens when your heart is working too hard, usually during exercise or other physical exertion. It’s a signal telling you your heart needs more oxygen. The pain subsides when you rest, and there’s a clear pattern of how much exertion triggers it. Narrowed arteries are often the cause of this type of angina.

Unstable angina is new or unusual chest pain. It refers to chest pain that’s getting worse, lasting longer, or coming on sooner. This form of chest pain is a warning sign of an impending heart attack. If you think your angina has become unstable, seek medical attention immediately.

How does a stent help?

In unstable angina, a stent is just one of the possible interventions used to prevent a heart attack. It opens the clogged artery before it becomes completely blocked, improving blood flow and possibly staving off cardiac arrest.

For stable angina, on the other hand, the benefits aren’t so clear cut. A 2007 study showed that the outcomes for patients who had a PCI and those who didn’t were virtually the same. Angina patients who had stents inserted were just as likely to have a heart attack as those who treated the angina with other methods. On the other hand, many patients reported higher energy levels and reduced chest pain after PCI. This led many doctors to believe the stents, while not effective for reducing heart attacks, do relieve chest pain.

New study surprises doctors

The double-blind, randomized study measured the effectiveness of PCI for patients with stable angina. The participants received either a PCI or a sham procedure that felt like a PCI. The patients did not know which treatment they received. When the researchers followed up on the participants’ pain levels, they found no difference in chest pain between the two groups.

While these results are in no way definitive, it does raise some valid questions. Are doctors recommending PCI simply because popular perception is that it works? Should the risks of the intervention outweigh the dubious benefits? Should all other possible treatments—medications, EECP therapy, and/or lifestyle changes—be considered before turning to stents?

At this point, we need further research to tell us whether or not we should discontinue stenting. But the information is there to discuss with your doctor should he or she recommend angioplasty with stenting.