eEarly use of stents may help patients with ischemia

A new study suggests that the early use of stents may help patients with coronary artery disease that have at least one narrowed blood vessel that compromises flow to the heart, compared to medical therapy alone. Patients who sought medical therapy alone were found to have a significantly higher risk of hospitalization and the urgent need for a coronary stent.

The study, published online in the New England Journal of Medicine (NEJM), was designed to evaluate the benefits of using a diagnostic tool called fractional flow reserve (FFR), to determine the best treatment for a narrowed artery. The study’s principal investigator is Bernard De Bruyne, MD, PhD, of Cardiovascular Center Aalst in Belgium.

“We believe there is a significant proportion of patients who benefit from stenting early on as opposed to receiving only medical therapy,” said William Fearon, MD, associate professor of cardiovascular medicine at the Stanford University School of Medicine.

Dr Featon is also co-principal investigator and senior author of the multi-centre international trial called FAME 2.

The FAME 2 trial used FFR, which involves inserting a coronary pressure guide wire into the artery to measure blood flow. The use of FFR helped doctors pinpoint patients that would benefit from early stenting, as it identifies vessels with blood flow reduced to a dangerous level.

“For this group of patients who have significant ischemia [blood vessel narrowing that compromises flow to the heart muscle] based on assessment with FFR, the need for hospitalization and urgent revascularization is much higher and the pain relief is much less when only medical therapy is prescribed. People feel better and do better with FFR-guided placement of coronary stents up front in this setting,” Dr Featon said.

About 40% of Americans over the age of 60 have one or more narrowings in the coronary arteries, caused by buildup of atherosclerotic plaque, with no symptoms or stable symptoms, a condition known as stable coronary artery disease. Many can be treated with medical therapy alone, which may include aspirin or statins.

The study included 888 patients with at least one stenosis — one significantly narrowed artery causing ischemia — identified with FFR. An artery was considered seriously narrowed if the blood pressure was 80% or less past the narrowing than the pressure in front of the narrowing. The patients were enrolled in 28 centres in Europe, the United States and Canada. Fifty of the patients were enrolled at Nike Zoom Live 2017