The Stent Debate
Reported January 19, 2009
(Ivanhoe Newswire) — New research suggests doctors may be implanting too many artery-opening stents. A new study says patient outcomes could improve if they used a method called fractional flow reserve (FFR) or measurements of blood flow in the vessels of the heart.
The study evaluates the benefits of FFR and looks at whether stenting was the best option for patients in the study group. “Not only were the outcomes better, the cost was less,” William Fearon, MD, co-principal investigator of the multicenter international study called FAME and assistant professor of cardiovascular medicine at the Stanford University School of Medicine was quoted as saying.
FFR examines arteries by way of a thin pressure wire that has a sensor near the tip used to measure the pressure of blood flow. “If the narrowing is truly significant it will cause a drop in blood pressure beyond the narrowing. If the pressure was 80 percent or less than the pressure in front of the narrowing (an FFR value of .80 or less), a stent was implanted,” Dr. Fearon said. The FFR tests runs an extra $700 versus $2000 for an individual stent.
The study compared traditional stent patients and FFR patients. Researchers found patients who received the additional blood flow test received one third fewer stents than the group examined only with an angiogram. After one year, 18.4 percent of the traditional patients had died, suffered a heart attack or needed a bypass surgery or a repeat stent procedure, compared with 13 percent of the FFR patients.
SOURCE: New England Journal of Medicine, January 2009