PHILADELPHIA – Stent and coronary artery bypass surgery are no more effective than intensive drug treatment and better health habits in preventing millions of Americans from heart attacks and deaths, a large study found, shed new light on the great controversy in cardiology.
Researchers and doctors have been fiercely debating for years the best way to treat people who have narrowed coronary arteries but don't suffer from acute symptoms.
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The standard treatment is to implant a stent – a wire tube that opens a blocked artery – or perform a bypass operation, directing blood around the blockage. The procedures are performed even though these patients have no symptoms or feel chest pain only when they climb a few steps or force themselves in other ways.
This research is the largest and among the most stringent studies that have not yet shown that while stent and bypass surgery can save lives for people who have had a heart attack, they are not necessarily better than cholesterol-lowering drugs and other changes in health habits for most people with chronic, or stable, coronary artery disease, which affects about 9.4 million Americans.
"You will not prolong life," said Judith Hochman, chair of research and senior dean for clinical science at New York University's Grossman School of Medicine.
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But stents or bypass surgery work better than medication and lifestyle changes alone in relieving symptoms for people who often experience angina, or chest pain, the researchers found.
The findings, which were released Saturday at the American Heart Association's annual scientific conference, should encourage more discussion between patients and their doctors about care, he said. "Statins and aspirin are very important," he said. "We need to understand better how to make people modify their risk factors." Lifestyle changes may be difficult to do and maintain, he said.
This story continues in The Wall Street Journal.