The broadcast explains that the cost of implanting a stent runs between “15 to 25 thousand bucks,” and suggests that the procedure is not cost-effective in about half of those currently considered candidates. The broadcast summarizes the trial’s results in general terms but does not report the actual number or percentage of heart attacks and deaths (the trial’s primary outcome). Over the course of follow-up, there were 211 deaths and nonfatal heart attacks in the group receiving stents plus optimal medical therapy, and 202 such events among patients receiving optimal medical therapy alone. After 4.6 years, the cumulative event rates in the two groups were 19% and 18.5%, respectively—nonsignificant differences. The broadcast does not mention potential harms of medical therapy or stenting. This information was also omitted from the trial’s published manuscript. What should a patient know about complications and other side effects associated with these treatments? A sentence summarizing harms reported in previous studies would have been helpful. The broadcast describes a large, randomized, controlled trial in which one group of more than a thousand patients received medical therapy and another group of equal size received medical therapy plus stents. The story does not mention that the new study was published in the New England Journal of Medicine simultaneous with its presentation at the annual meeting of the American College of Cardiology. Nor does it mention previous smaller studies that reached much the same conclusion. The story is careful to distinguish between coronary artery disease that is characterized by unstable, potentially dangerous angina and “stable situations” that are less likely to result in heart attacks and death. Rather than stirring up fear about disease, the broadcast is appropriately reassuring, pointing out that millions of people with stable angina can be safely treated with medication alone and do not require stents. The broadcast includes interviews with two experts, though it fails to provide details about their potential conflicts of interest, including the fact that Dr. Boden was the principal investigator of the trial under discussion.
Heart stents found no more effective than drugs in prolonging life