Some common heart procedures may be more common than they should be, a large-scale study led in part by a Kansas City doctor suggests.
The study, which involved nearly 5,200 patients in 37 countries, found that, in some situations, heart disease patients who received invasive treatment such as stents fared no better than those who got less invasive treatment.
The study’s results were presented at the annual meeting of the American Heart Association in Philadelphia on Nov. 16 by Dr. John Spertus, a cardiologist at Saint Luke’s Mid America Heart Institute in Kansas City and a professor at the University of Missouri–Kansas City.
Spertus said the findings should help doctors provide the most suitable treatments for their patients.
“We should be tailoring our treatment recommendations to the goals and values of each individual patient, and with this data I think we can feel very comfortable now going forward and be able to explain much more clearly what the advantages of a more invasive strategy is and what the disadvantages are,” Spertus said.
The International Study of Comparative Health Effectiveness With Medical and Invasive Approaches, or Ischemia, followed the outcomes of two groups of patients with artery blockages. One was treated using procedures that unclog arteries and the other was treated with medication and lifestyle changes.
The researchers found few significant differences in the rates of serious outcomes such as cardiac death, heart attacks or hospitalizations over a four-year period.
The insertion of a stent, however, did reduce chest pain, or angina, during exercise.
Experts say the much-anticipated results of the $100 million study suggest that many patients who do not have angina should be treated more cautiously, with statins, exercise and smoking cessation.
“I think, as cardiologists, we are looking for guidance and we are looking for what’s the appropriate use of this significant technology that continues to develop around the aggressive management of heart disease,” said Dr. Willie Lawrence, a cardiologist at Research Medical Center in Kansas City, who was not involved with the study.
Lawrence called the study “really impressive work.”
Spertus, who was one of the leaders of the Ischemia study, says the results confirm many of his own beliefs about treatment deriving from his own research and practice.
“I have been advocating for 25, 30 years that how patients feel, what their symptoms are, what their quality of life is like, is very important and that we ought to be playing much more attention to that in clinical trials,” Spertus said.
Alex Smith is a health reporter for KCUR. You can reach him by email at alexs@kcur.org
