Diagnostic tool could reduce needless stent procedures

16 January 2009

Scientists have tested a new diagnostic tool designed to determine whether stenting really is the best option for individual patients.

Artery-opening stents are commonly used in patients with coronary artery disease, with some cardiologists routinely implanting a stent in any artery that looks significantly narrowed on X-rays from a coronary angiogram.

However, many experts are concerned that stents are regularly used in patients whose arterial narrowings are not significant enough to limit the oxygen supply to the heart.

These patients could be treated effectively with drugs such as statins or aspirin but are hard to identify from an angiogram alone.

The new tool involves a coronary pressure guidewire which is inserted into the artery to measure the flow of blood to the heart - a method known as fractional flow reserve (FFR).

Researchers trialled the method in around 1,000 patients in Europe and the US, all of whom were suffering from chest pains or had recently had a mild heart attack and had multiple narrowed coronary arteries.

Patients who received the blood flow test received one third fewer stents than those who were examined using the traditional angiogram.

Just 13.2 per cent of those who received the blood flow test died, suffered a heart attack or needed bypass surgery or a repeat stent procedure within one year, compared with 18.4 per cent of the patients who just had an angiogram.

Dr William Fearon, co-principal investigator and assistant professor of cardiovascular medicine at the Stanford University School of Medicine, commented: "The take-home message is that the wire is able to give you more information about whether a coronary narrowing is truly causing abnormal blood flow to the heart.

"Some narrowings that might look bad would respond just as well to medication, while others that appear innocent may benefit from stenting."

Dr Fearon noted that the cost of treatment was also lower for patients who did not receive unnecessary stents.

He concluded: "Now there's scientific support for cardiologists to apply this new technique."

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