HEALTHY LIVING


There may be a good case to be made for stenting stable angina in some circumstances.” — Farshad Forouzandeh, M.D., Ph.D.


done under twilight sedation and local anesthesia, a catheter is inserted through an artery toward the heart. Using a moving and live X-ray


called fluoroscopy, an interventional cardiologist guides special tools through the catheter to the blocked artery and inflates a balloon to widen the artery and restore blood flow. In almost all cases today, an expandable metal mesh tube coated with medication, called a stent, is left behind to maintain blood flow.


WHO CAN BENEFIT? “Most stents are placed to restore blood flow to the heart and improve survival for someone with different types of heart attacks, or unstable angina that is basically a pending heart attack if not treated appropriately and promptly. “In these cases, time is muscle,


placing a stent is an urgent or emergency procedure to save heart muscle from dying. “There is no debate about


these stents. They are necessary because they prolong survival,” says Forouzandeh. Unstable angina causes chest pain


that is unexpected, new, worsening, or persisting. It does not get better with rest or respond to medication. It may start while you are resting. Unstable angina is a real


emergency because it may get worse and cause a heart attack. Along with angina, symptoms may include difficulty breathing, nausea, sweating, and dizziness.


WHO MAY NOT BENEFIT? If you have stable angina that responds to medication or rest,


84 NEWSMAX MAXLIFE | FEBRUARY 2024


studies have shown that having a stent placed is not better for survival than managing the condition with medications. A symptom of stable angina is


chest pain when you exert yourself that is relieved by rest or medication. This type of chest pain is usually familiar and predictable. “In these cases, a cardiac stent is


only indicated for symptom relief and improved quality of life, especially if a patient cannot tolerate medications or fully respond to them,” says Forouzandeh.


GRAY AREA The report on unnecessary coronary stents was based on a survey that counted all stents not done to treat unstable angina or heart attack as unnecessary. These were elderly people diagnosed with coronary artery disease for at least six months with no symptoms of heart attack or unstable angina. “Guidelines are not meant to


limit, only to guide. There are many situations where a stent might be of benefit to someone with stable angina. They may have side effects from their medicines and prefer a stent,” says Forouzandeh.


GAME CHANGER The Orbita-2 study came five years after the first Orbita study which found no benefits for treating stable angina with a stent. However, many cardiologists still


felt there were cases when stable angina could benefit from a stent, and there was some criticism of the first Orbita study because it had a small


sample size and patients were only followed for a short time. “The second Orbita trial was


the largest study done to find out if people with stable angina symptoms could benefit from PCI and a stent,” says Forouzandeh. In the trial, researchers randomly


assigned people with stable angina taken off medications to a stent placement or to a simulated procedure that did not actually include stent placement (called the sham control group). Neither the patients or their doctors knew who got the real stents. This study found that compared


to the placebo group, the stent group participants were three times more likely to be free of angina, were able to increase their exercise time, and that these benefits were still present one year after the procedure. This study suggests that stents can


be beneficial not just for survival but also for quality of life and relief of angina. “There may be a good case to


be made for stenting stable angina in some circumstances,” says Forouzandeh. “The best advice is to make a


shared decision with your doctor, balancing the risks and benefits for you based on your risk, your age, your activity level, and other factors. Both risk factors and benefits are different for everyone.” The bottom line for anyone with


angina is to base your decision on a discussion with your doctor, not on headlines in the media. Unstable angina or heart attack


symptoms demand a 911 call. Do not try to drive yourself to the hospital.


POPTIKA/SHUTTERSTOCK


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