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Can Newer Stents Benefit Heart Disease Patients More? Many people might wonder what a stent is? A stent is often placed in an artery as part of a procedure called angioplasty, which restores blood flow through narrow or blocked arteries. It is a small mesh tube that helps prevent the artery from closing again after angioplasty. A stent is usually made of metal but sometime it can be made of fabric. Fabric stent, also known as stent graft, is used in larger arteries. There is a type of stent called drug-eluting stent. It is coated with medicine, which is released into the artery gradually. It is believed the medicine coated on the stent can help prevent the artery from becoming blocked again. While many patients get newer, pricey stents inserted during angioplasty, many of them were not aware that these newer stents could be worse off with those more basic, less expensive stents. This was what researchers from Massachusetts General Hospital in Boston reported on August 13, 2012 in the ‘Archives Of Internal Medicine’. Besides being more costly, the drug-eluting stents require patients to take aspirin and other blood-thinning drugs for a longer period of time after angioplasty. This also means that these patients might not be able to undergo future elective surgery because of bleeding risks.
According to researchers, some patients, including people with diabetes or narrow arteries, are at a higher risk of their stent getting clogged. These patients might then need a repeat procedure. The drug-eluting stents could help prevent build-up in and around the stent and avoid future surgery. However, for those patients whose stents would probably not get clogged, the old type of bare-metal stents should work just good and at a much lower price. In fact, the rate of restenosis can be quite low for non-diabetic patients having big arteries and have very short blockages, even with the bare-metal stents. In the study, data on 1.5 million patients who had a stent inserted between 2004 and 2010 in the United States were examined and analyzed. Researchers found that almost 75 percent of the patients, who were at a very low risk of getting a repeat stent-inserting procedure, received drug-eluting stents. In comparison, 83 percent of the higher-risk patients had more to gain from the extra protection. It is estimated that surgeons use newer stents for between 2 and 100 percent of their procedures. Newer stents can cost up to US$1,000 more per patient than the more basic stents. Calculation showed that more than US$200 million per year on heart procedure, or about US$340 per procedure, would be saved if half of the low-risk patients given a drug-eluting stent received a bare-metal stent instead. Health experts not involving in the study generally agreed that the higher-risk patients should use drug-eluting stents whereas the lower-risk patients should still stick to the old bare-metal stents. Using more expensive stents could be a waste of money for patients who do not need them. The new findings reflected the fact that technology was somehow overused and health care cost was misused, too. It is rather sad that the prevailing practice is to use the most expensive and newest therapeutic options instead of much cheaper, evidence-based therapies. Therefore, it is important for patients to know an estimate of their risk of needing a repeat procedure and what are the implications of the different stent alternatives. The doctor or surgeon has the obligation to provide patients with relevant information for them to decide. Meanwhile, patients should also understand that the coronary angioplasty performed would not totally cure their coronary artery disease. They should still pay attention to lifestyle factors. For instance, they should stop smoking and eat healthy diet coupled with regular exercises. More importantly, they should take heart disease medications prescribed by their doctors accordingly.
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