A recent study led by researchers at Imperial College London and Imperial College Healthcare NHS Trust suggests that some patients with chest pain due to reduced blood flow to the heart may benefit from having a stent implanted rather than relying solely on chest pain medications.
Stents are tiny tube-shaped devices that help keep narrowed blood vessels open. In the study, patients who received a stent reported improvements in chest pain and their ability to exercise when compared to patients who underwent a placebo procedure.
The research, known as the ORBITA-2 trial, challenges the current American and European guidelines for treating patients with angina and suggests that these guidelines should be updated.
The ORBITA-2 study builds upon a previous trial from 2017 (ORBITA) conducted by the same research team, which found that stents did not provide significant additional benefits compared to medication in terms of exercise capacity, symptoms, or quality of life.
However, in the ORBITA-2 trial, patients discontinued their chest pain medication before receiving a stent or placebo procedure, revealing different results.
Analysis of the ORBITA-2 trial data showed that more than one-third of patients who received a stent were free of angina symptoms at the end of the trial.
Patients who underwent stent implantation were also three times more likely to have no angina compared to those who received the placebo procedure.
However, it’s worth noting that stenting was not effective for all patients, as 59% of those who received a stent continued to experience chest pain even after the procedure.
The study’s lead author, Dr. Rasha Al-Lamee, emphasized that stents are not without risks or costs, and their use should be carefully considered.
The study suggests that stents may be most effective when used as an upfront procedure in patients who do not respond adequately to chest pain medications.
In total, the study enrolled 301 patients across 14 sites in the U.K., and participants were unaware of whether they received a stent or a placebo procedure.
The positive effects of stenting were immediate and continued throughout the 12-week follow-up period.
The study has prompted discussions about potential updates to the guidelines for treating stable coronary artery disease, allowing more flexibility for patients and clinicians to choose the most appropriate treatment based on individual responses and needs.
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The research findings can be found in the New England Journal of Medicine.
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