Stents used to prop open clogged arteries raised costs for treating chronic chest pain by $10,000 a person and didn't help patients live longer, a study found.
The research analyzed costs from an earlier trial that said stents and angioplasty, a procedure using tiny balloons to flatten artery clogs, worked no better than aggressive drug therapy. Most treatment benefits stemmed from medication, including aspirin and Bristol-Myers Squibb Co.'s Plavix, given to both sets of patients, the study found.
The initial results, plus studies linking drug-coated stents to deadly blood clots, contributed to a 40 percent drop in use of the devices sold by Boston Scientific Corp. and Johnson & Johnson during the third quarter. The findings should lead doctors to further consideration before using stents as a first treatment, researchers said.
"You're spending more money and getting less gain," said William Weintraub, professor of medicine at Christiana Care Health Services in Newark, Delaware, and the lead investigator. Weintraub reported the results at the American Heart Association's annual meeting.
Artery clearing "as an initial management strategy has not been shown to reduce the incidence of death or heart attack, or prolong life, and is more expensive," he said during a news conference at the meeting Sunday.
A second analysis from the original study, dubbed Courage, found that using advanced nuclear imaging techniques to find the most troublesome blockages can improve the results for patients. Clogged arteries don't always reduce blood flow to the heart, since new vessels can grow to provide the needed supply.
Identifying the clogged arteries that are doing damage with CT imaging scans and clearing them yields better results than drug therapy alone, the study found. A follow-up scan done six months to 18 months later found angioplasty reduced ischemia, the damage from blocked arteries, by 2.7 percent, while drugs yielded a 0.5 percent benefit. Some patients also had a significant recovery of heart muscle, the study found.
High-risk patients with the most ischemia fared best when given angioplasty and drug therapy, said Leslee Shaw, a cardiologist at Emory University School of Medicine in Atlanta.
A third study provided reassuring findings about the safety of the drug-coated heart stents. In a registry of 20,000 patients treated in Massachusetts from April 2003 through December 2004, the newer drug-coated devices weren't linked to more heart attacks or deaths than bare metal versions.
The results echo findings from other medical database reviews showing Boston Scientific's Taxus and Johnson & Johnson's Cypher, the two drug-coated stents now approved in the U.S., don't substantially increase the risk of heart complications.
"We were relieved, since most of the stents used in Massachusetts are drug-eluting," said lead researcher Laura Mauri, an assistant professor of medicine at Harvard University. They are widely used to reduce the need for repeat procedures within the first year after treatment, she said.
The devices generated about $3 billion in the U.S. in 2006. Analysts are now predicting sales of about $1.8 billion for 2007, as doctors reduced their use of the drug-coated versions that cost about $2,200 during the year.