One-third of heart stent implants 'unnecessary'
Thursday August 14 2008
Heart stents to prop open diseased arteries have little advantage over medicines, exercise and a better diet, according to researchers who said the devices should be a last resort for most patients.
Stents provided patients an "incremental" benefit in reduced pain and fatigue after surgery, which by three years was equalled using anti-cholesterol drugs with an exercise and diet plan, the study in yesterday's New England Journal of Medicine said. An accompanying editorial said a third of the one million stents implanted in the US each year may be unnecessary.
The study poses an obstacle for stent manufacturers led by Johnson & Johnson and Boston Scientific Corp. The devices may generate $5bn in sales next year.
"There are a lot of forces, in terms of payment, the influence of manufacturers and all the shiny, new devices that are coming on to the market, that are encouraging use," said Eric Peterson, a Duke University cardiologist who co-wrote the editorial. "There is enormous incentive in the medical industry to put things in patients."
Guidelines
Physicians and insurers are starting to take notice, Peterson said. A subcommittee of the American College of Cardiology is rewriting its angioplasty guidelines, and Medicare and Medicaid, the US government insurance systems, have commissioned a study of the procedure's value.
The study, tracking 2,287 patients, was the second installment of a seven-year investigation. Last year, researchers said a regimen of drugs, exercise and changes in diet worked as well as stents to avoid deaths and heart attacks.
The 2007 results, released in March, sent Boston Scientific shares down 9pc over two days; J&J lost 1pc. They came six months after researchers said that newer stents which are coated with drugs to reduce scarring in arteries might raise the risk of deadly clots, causing sales of the stents -- which cost $2,000 each -- to plunge.
- Alex Nussbaum
