In 2019 Stanford and New York Universities published an international research report showing that for patients with stable severe coronary heart disease there was little difference between patient outcomes between those patients who were treated with stents or Bypass operations and those patients that were treated with medication and changing their lifestyle.
What has been the medical professions response to these findings?
Has been largely positive, largely negative or a roughly equal mixture of both?
Written by
Tenyards
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I was on a similar trial, ORBITA, to see if stenting or not was beneficial for those with severe blocked LAD.. I was taken off all medication after a blind angiography when I didn't know whether I had had a stent or not. At the end of the six months I discovered I had had the stent and didn't need any of the anti angina meds. The trial I believe is running until next year when the results will be publushed.
"The ISCHEMIA trial failed to show that routine invasive therapy was associated with a reduction in major adverse ischemic events compared with optimal medical therapy among stable patients with moderate ischemia."
In many studies, the importance of which outcomes that are measured by the researchers may be different from patients.
In some cases it's mortality which is considered to be the most important outcome.
However many studies don't consider quality of life such as a reduction in angina symptoms.
Invasive treatments such as stents can reduce the symptoms of angina without increasing an individual's life span.
The ISCHEMIA trial caused a great debate within the cardiology community.
Cardiothoracic surgeons perhaps arguing that surgery out trumps interventions such as stents.
Well they would wouldn't they?
The other caveat is that the trial was considering moderate ischaemia.
I live with a rare type of myocardial ischaemia caused by transient constrictions of my coronary arteries, vasospastic angina. My coronary arteries are unblocked.
The only treatment option is by medication.
I live with frequent episodes of angina and experience at least one or two major cardiac events each year.
However after 11 years I am still here, keeping my Cardiologist busy 😊
You use the words "optimal medical therapy". Outside of a carefully monitored scientific trial it is unlikely that the treatment regularly received would be optimal consistently and over an extended period.
It tends to be that once a treatment has been carried out then continuing therapy can be hit and miss.
I don't know if the ORBITA trial.I was on is the same as you were talking about. I know it is a collaboration between Basildon cardiothoratic Centre and Imperial College London. I do know from my point of view, the fact I did have a stent and could change me off my anti angina meds made a great deal of difference to my life, especially as I had a pretty stressful time a few weeks after having the angiography as part of the trial. My mum who was 104 and still living in her own, fell, broke her hip and never recovered, dying a couple of weeks after the fall. Before you ask the trial is sponsored, but not by any company who supplied stents to the hospital.
Happened to run into my Basildon doc at Broomfield hospital, where I volunteer, the other week and he said they were extending trial, I think there were not to many folks, like me, willing to take part. I was told it was a 6 to 7 month wait to get a stent for my blocked LAD, so I reckoned it was worth taking the risk I might have to undergo another angiogram to stent as I had a 50/50 chance of receiving stent as part of trial. I think us volunteers for trial will get full results and may be asked if we are willing to video our experiences. Personally I don't regret it and my doc who was running the trial as part of his cardio clinical fellowship was an absolute star I could contact him at any time if I had problems.
Participants in studies like the ORBITA trial are the unsung heroes of clinical trials. It would so good to see videos of the volunteers speaking about their experiences.
Depends on individual circumstances as to these outcomes, also optimal drug therapy is fine during a trial study but all drug regimes have to be tweaked and altered on a regular basis and from my experience it is rare for a GP to take you off a medication you have been prescribed! so usually prefer to add another tablet to your regime as they deem suitable. This ends up with the patient taking some meds that are not doing any good and as with all meds probably some degree of harm. In my opinion after a trial a patient ends up with far less than optimal medication and a cocktail of meds which they dont need. If your arteries are severely comprimised bypass or stenting seems to be the logical tried and tested method of treatment. I also read in lots of studies the a blockage of the LAD or left coronary artery should be stented or bypassed as drug therapy for it was very risky.
It was only the docs who were running the trials who were able to put you back on any meds. I did go back on amlodipine earlier this year whilst on the trial as had a bad bought of angina brought on by the stress of worrying about colonoscopy, which thankfully showed nothing up.apart from 3 little pockets of diverticulitis. Been doing the bowl cancer testing thing every 2 years since I was eligible and and it was the very last one I would be Sent, as too old now, that showed up traces of blood. Blame it on the clopidogrel and aspirin.
Glad the scope was Ok, why they have an age limit on the bowel cancer testing baffles me to be honest!!. Its a bit like your old now and do not matter as much (weird). The Clopidogrel and Aspirin will probably cause the blood show alright.
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Medication blackmail!!!!
To medicate or not to medicate, that is the question 🤔
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