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To Stent or Not: Is That the Question?

Reporting of COURAGE study results confused the public about the need and benefits of angioplasty

PORTLAND, Ore., June 07, 2007 /PRNewswire/ -- The onslaught of anti-stent news reports over the past few months has shaped the public's view that angioplasty doesn't work and its use should decrease. Confused by the media coverage, patients have extensively questioned their cardiologists about the benefits of stenting.

"Doctor and patient dialogue is always good," said Dr. Skip Freedman, Executive Medical Director for AllMed Healthcare Management. "But there's really no controversy over the COURAGE study, because it says that nothing has really changed." COURAGE is short for the full study name Clinical Outcomes Utilizing Revascularization and Aggressive Guideline Driven Drug Evaluation.

Many consumers have misread stories in the press about stents and angioplasty as involving patients undergoing a heart attack and in dire need of either angioplasty or clot-busting medications. But this wasn't the case. The COURAGE study looked at only rather low-risk patients who are in a stable condition.

The real message is that the study reinforces long-standing clinical practice guidelines for chronic stable angina from the of Cardiology and the American Heart Association. These treatment guidelines recommend that stable angina patients start with the best medical therapy and only receive angioplasty if their chest pain continues. What the study shows is how effective medication is for fairly low-risk patients who are in a stable condition.

Has anything changed?

"The study shows that patients have a choice -- they can delay stent implantation if medication and lifestyle changes provide satisfactory freedom from symptoms," said Freedman, who is also an emergency room physician. "It says that doctors must use medication aggressively and counsel low-risk patients about the trade-offs of the two therapies. And by reinforcing a proven treatment, it leaves room for health insurers to argue for controls over angioplasty as a purely preventive measure."

According to Freedman, the study results may prompt some hospitals to compare their practice patterns to ACC/AHA guidelines. Risk managers concerned about their hospital's utilization of angioplasty services might also consider external peer review to assess appropriateness of individual cases, and to identify any departures from evidence-based recommendations.

But Freedman doesn't think hospitals that have adhered to the ACC/AHA guidelines need to change what they do. Still, patients who experience angina pain despite medical therapy may elect to have angioplasty to reduce chest pain -- just as one third of the patients in the study did.

"It's unfortunate the press and public misunderstood the populations studied and simplified the study results, pitting angioplasty against medication," said Freedman. "Both are viable solutions for treating stable coronary disease. They are complementary, not competing, solutions."

For more information on making informed decisions on whether angioplasty and stenting is medically necessary, visit AllMed's web site at

CONTACT: Martin Middlewood, +1-360-882-1164, , forAllMed Healthcare Management

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