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Early use of stents better than medical therapy alone for certain patients
Date:8/27/2012

STANFORD, Calif. For patients with stable coronary artery disease who have at least one narrowed blood vessel that compromises flow to the heart, medical therapy alone leads to a significantly higher risk of hospitalization and the urgent need for a coronary stent when compared with therapy that also includes initial placement of artery-opening stents.

Those are the findings of a study to be published online Aug. 28 in the New England Journal of Medicine that was designed to evaluate the benefits of using a diagnostic tool called fractional flow reserve, or FFR, to help determine the best course of treatment for fixing a narrowed artery.

"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 and co-principal investigator and senior author of the multi-center international trial called FAME 2. "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."

The study's principal investigator is Bernard De Bruyne, MD, PhD, of Cardiovascular Center Aalst in Belgium.

The trial was halted early, on Jan. 15, because of the high rates of hospitalization and coronary stenting needed in the patients with significant ischemia who received only medical therapy. Some of those patients had suffered subsequent chest pain and heart attacks requiring urgent revascularization, which entails repairing damaged blood vessels with emergency stenting or heart bypass surgery.

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Contact: Tracie White
traciew@stanford.edu
650-723-7628
Stanford University Medical Center
Source:Eurekalert

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