This Wall Street Journal story describes surprising news that a very common procedure– inserting a stent to open a blocked blood vessel — does not add benefit over medication in patients with angina. Angina is chest pain due to blocked heart arteries, and is common among people with heart disease.
One strength of the story is the detailed description of the study itself and in finding outside sources to critique aspects of the study. We do think the cost of the procedure was worth discussion, as well as the potential harms, but they were not addressed in this story. These points were raised in the New York Times story, which we also reviewed.
Heart disease is still the leading killer of Americans so any news about treating aspects of heart disease, such as blocked arteries, is newsworthy. In addition, this story suggests that stenting — common, but expensive — is a prime example of over-treatment.
The story does not mention the cost of stent insertion, which can run into the tens of thousands of dollars.
The story describes the main outcome measure — how long subjects could exercise on a treadmill before experiencing pain — and the change in exercise duration — a 28 second improvement after stent insertion versus 12 second improvement after sham surgery. Readers are told that no statistical difference exists between those averages.
The story does not mention harms of the procedure, which should be a factor in weighing the risks and benefits of any intervention.
The story describes the study’s size and methods and goes into some depth about how the sham procedure can control for placebo effects. Limitations were discussed, as well. The story also provides some critiques from outside sources, including the fact that study subjects, with only one major blockage, do not represent the majority of patients to whom doctors recommend stents.
No disease mongering here. It was good to see the story discuss the concerns around over-use of stents.
The story quotes one of the study authors and authors of an accompanying commentary in the journal, The Lancet. The reporter also sought comment from stent makers, who were mostly critical of the study — but these potential conflicts were made clear to readers.
The story, in describing the study, makes clear that management of angina pain with medication is equally effective in these kinds of patients.
The story makes clear that stent insertion is widely available and frequently done.
The story makes clear that what is novel about this research is the use of a placebo group whose participants underwent procedures but didn’t receive a stent.
The story goes well beyond what is contained in the news release from the host institution, Imperial College.
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