Stents or drugs? Huge question in heart care

'Huge vested interests'
“There are huge vested interests that are going to push back on these results, and they have already begun to do so,” Dr. Salim Yusuf of McMaster University in Hamilton, Ontario, said at the meeting.

For years, smaller studies have shown angioplasty has little to offer over other treatments, he said. “Medicine here has gone wrong,” he declared to big applause. “We’re going to have a helluva tough time putting the genie back in the bottle.”

Some argued that patients themselves may thwart the new advice. Drugs work “if you can get patients to take their medicines,” said Dr. Gregory Dehmer, a Texas A&M cardiologist who heads the Society for Cardiovascular Angiography and Interventions, the doctors who specialize in angioplasty.

Even doctors who believe the study’s results predict patients will still demand angioplasty, just as many choose obesity surgery rather than diet and exercise to shed weight, said Dr. Deepak Bhatt of the Cleveland Clinic.

“We all like a quick fix,” he said. “They don’t want chest pain because it keeps them from enjoying life. That’s especially true of baby boomers.”

Boon for heart drugs
It seemed to surprise everyone that modern heart drugs worked as well as they did.

Dr. Roger Blumenthal, chief of preventive cardiology at Johns Hopkins University, cited combo pills like Caduet, which lower cholesterol and improve heart functions. “For a lot of people, two pills might be all they really need,” he said.

Still, many patients believe they are being denied the best care if doctors don’t open the artery, said Dr. Martin O’Riordan, a cardiologist in private practice in Philadelphia.

“Even when you try to talk them into conservative medical therapy, many of them want to have the vessel opened. They say, ’I want it fixed.’ They think it’s a cure,” he said.

Insurers may decide whether that happens in the future.

Dr. Alan Rosenberg, a vice president at WellPoint Inc., said it will take months to fully review the study, but predicted that the company eventually would review more claims to make sure angioplasties were medically necessary before paying for them.

“I think we’ll see less of the procedures being done,” he said.

Cigna Corp. said its coverage will not change, “as this is a decision that should be made between a physician and his patient” based on individual circumstances. UnitedHealth Group Inc. said it was too soon to know the study’s impact.

“It isn’t going to kill angioplasty, but it is going to cut into it, probably appropriately,” said one of its leading practitioners, Dr. Spencer King of Piedmont Hospital in Atlanta.

He predicted a 10 percent drop in procedures, “not huge.”

Boden, the study’s leader, said too many doctors “pay lip service to evidence-based medicine” but don’t practice what they preach.

“I hope that people will look at this ... and give us a fair shake, rather than say, I don’t believe the results, I don’t like the results, and I’m going to reject them.”

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