Cardiac stents fall short versus surgery, drugs in 2 new JAMA studies

Cardiac stents lose out in two new studies that conclude bypass surgery and drugs are better or equal options in helping to prevent future heart attacks from happening, at least for patients with stable heart disease. Such a finding could trigger lower stent use down the line--bad news for Abbott ($ABT), Medtronic ($MDT), Boston Scientific ($BSX) and other manufacturers that continue to face a stagnant market for the devices.

Both studies are published in the journal JAMA Internal Medicine, and the Boston Globe highlighted the key results.

One study, involving researchers from the U.S. and Turkey, assessed more than 6,000 patients in 6 randomized trials who suffered from multiple clogged arteries, comparing coronary artery bypass surgery to stent treatment. They found significant data that showed the bypass surgery option contributed to a major reduction in heart attacks or death compared to the stent option. Surgery also helped reduce repeat procedures to reopen clogged arteries, the researchers said.

The second study, which included a team from multiple research centers in the U.S., Germany and Brazil, looked at the use of stents and drugs to treat patients with stable coronary artery disease, versus drugs alone. In 5 trials involving nearly 5,300 patients with a single clogged artery, researchers didn't measure any reduction in heart attacks, repeat procedures or death with a combined stent/drug treatment, versus drugs on their own.

Both studies are not definitive, as the Boston Globe noted, because they only looked at patients with stable heart disease. And an expert is quoted in the article pointing out that stents can still be vital to saving the life of patients in the midst of a heart attack or other cardiac emergency. But the research in both cases packs a punch because cardiac stents have long been promoted as a treatment for patients who also have chronic but stable heart disease, and the research shows that stents don't necessarily offer any added benefit. Consider a surgeon looking at treating a patient with drugs and stents, versus drugs alone. If the research concludes both options are equal, in the current healthcare climate, the cheaper option wins--drug treatment. There's no other way to say it: That's bad news for stentmakers.

The expert in the Globe story--Dr. Valintin Fuster, director of the Mount Sinai Heart Center in New York and a past president of the American Heart Association--is quoted as saying that his institution and others have reduced stent use in favor of additional bypass procedures and drug treatments, based on other research indicating they produce better outcomes. While that may be a great result for patients, it is a warning sign for cardiac stent manufacturers if their products aren't producing results that match their promoted benefits. Medical experts have also become increasingly concerned about stent overuse, and both studies add two more reasons to cut back.

- read the study abstracts here and here
- here's the Boston Globe's take

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