MONDAY, Feb. 27 (HealthDay News) -- Many populate with stable heart disease undergo one expensive artery-opening procedure when medication would labor just as well, a new study suggests.

The conduct involves placing a tiny mesh stent, or hollow cylinder, in a clogged artery. As manifold as three-quarters of these operations are unnecessary, said lead researcher Dr. David L. Brown, a professor of remedial agent at Stony Brook University Medical Center in New York.

Money is the driving troop, Brown said. "Everybody gets paid to incite in stents, the hospital gets paid, the savant gets paid, the stenting company gets paid," he afore~. "It's how our fee-during-service environment has taken over the decision making of this branch of cardiology."

Stenting costs an average of $9,500 more to the invalid over a lifetime compared with medication, Brown before-mentioned. Although the procedure, called percutaneous coronary mediation, reduces death and future heart attacks by reason of someone actually having a heart make a run at, its use in stable heart disease patients is questionable, he noted.

For the study, published Feb. 27 in the Archives of Internal Medicine, Brown and Dr. Kathleen Stergiopoulos, one associate professor of clinical medicine at Stony Brook, analyzed eight trials involving other thing than 7,000 patients randomly assigned to sanatory therapy or stenting plus medication. The trials were begun betwixt 1997 and 2005.

In this impressed sign of study, called a meta-parsing, researchers look for patterns that puissance not have been the main close of the individual trials.

During one average follow-up of more than four years, no significant differences were seen in longevity or humor of life.

Overall, 649 patients died, 322 who accepted stents and 327 who received medication alone, the study mould. Nonfatal heart attacks were suffered ~ dint of. 323 patients with stents and 291 pleasing only medication.

Among those with stents, 774 needed new procedures to open blocked heart arteries. Among those put ~ medical therapy, 1,049 also needed a process to open blocked arteries.

Of additional than 4,000 patients for whom given conditions on chest pain -- called angina -- was to be turned to account, 29 percent of those with stents had persisting chest pain compared with 33 percent of those in successi~ medical therapy alone, Brown found.

There is ~t any data that stenting patients with steadfast heart disease reduces the risk of end of life or having a heart attack, Brown uttered.

"This is not to say none one will need stenting, but no other than about a third of patients treated initially with medical therapy will need to mark with a line over to stenting," he said.

"People shouldn't blindly agree to be seized of procedures unless the doctor can give an account of them that there is a documented favor" in quality or length of life, he declared.

Quality of life involves relief of chest pains, he said. If patients attached the best medication still have trunk pain that is unacceptable to them, stenting becomes appropriate, Brown before-mentioned.

Medical therapy included aspirin to hinder clotting, beta blockers and ACE inhibitors or angiotensin receptor blockers to govern blood pressure, and statins to sink cholesterol, the researchers noted.

"If you proceed the medical therapy route, it substance the patient has to be followed in every outpatient environment to see how they are responding to the curative therapy, and that takes time and exertion that doesn't reimburse very well," he before-mentioned. "That's part of the equation that drives putting in a stent rather than following the patient on curative therapy."

Dr. James Blankenship, a prolocutor for the Society for Cardiovascular Angiography and Interventions, wasn't surprised by the study.

"This is largely not new news and many interventional cardiologists are avoiding the pitfalls that the authors are pointing loudly," he said. "In fact, the mass of interventions among Medicare patients has gone downward 18 percent between 2005 and 2010."

"For frequent people, conservative medical therapy is the erect thing, but for those who be in possession of a lot of symptoms, having a coronary agency is a reasonable strategy," he said.

Dr. Gregg C. Fonarow, co-monitor of the University of California, Los Angeles Preventive Cardiology Program at the David Geffen School of Medicine, agreed that curative therapy is the first choice conducive to patients with stable heart disease.

Coronary stenting should have ~ing reserved for those patients who be seized of worsening symptoms despite optimal medical therapy, he uttered.

For patients with stable coronary artery ailment, "the most effective and valuable therapy to thwart disease progression, heart attacks, stroke, heart failure and premature cardiovascular death is a alliance of medications together with lifestyle state," Fonarow added.

More information

For more information on heart disease, visit the American Heart Association.

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