Good morning! I shared a few weeks ago that I was going to return to my fictitious NPR host to talk about the sham stent study (ORBITA)
. Thanksgiving happened and then I felt you guys needed a week off from the newsletter madness. Your reprieve is complete. Shucks.
Jan: Good morning Dr. Subaheeri…Sabahari…Subgeer? Thank you for coming back. She is locked above my eyes. I know it’s radio but this is rude.
Me: Please call me David, we’ve been through this. For those of you who can’t see me, I’m looking pretty…good. I always like getting dressed up for radio. It’s going the extra mile. You know what I mean?
Jan: Let’s dive right in to this stent study. So stents aren’t good for you anymore?
Me: Not true…but we do need to discuss this. I would like to remind your listeners that if you are having concerning symptoms and you call 9-1-1 (do that) you should let them stent you. It could save your life in the acute setting or with unstable angina.
Jan: That’s what I said.
Me: No it isn’t.
But, now we have new(er) important information that we learned last month. Back in 2007 with the COURAGE
trial we reaffirmed that stents do not prevent heart attacks or prolong your life in stable coronary artery disease. We did leave 2007 thinking that these stents reduced angina. Well…this new trial shows maybe they don’t do any better than classic anti-anginal (read chest pain reducing) drugs such as beta blockers and nitrates. They don’t improve exercise time to a level of statistical significance.
Jan: I’m sorry David. I’m SO distracted. Do they sell red felt fedoras with quail feathers in Columbus or did you buy that out of town?
Jan: Congratulations. She covers her mouth and hits the mute button. Straight face is now gone. I think I hear the producer laughing in her earpiece. Cheap equipment. After what felt like a full minute of dead air…
So, Dr. Sadgirl. I’m sorry. What’s the takeaway for our listeners this morning. She’s gets this out before she again hits mute and ducks her head under the desk. She’s unable to continue the interview.
Me: I thought you wanted me here for 20 minutes?
Just like every other study, this is controversial. I would encourage you to ask your cardiologist their thoughts. My belief is that, based on this trial, doctors are now more justified than ever pursuing an optimal medical therapy approach for their patients with stable CAD. Lifestyle choices such as regular physical activity
, eating a heart-healthy diet
and not smoking are just as good as stents in the patient with stable CAD.
Jan: Oh my G-d, this is so boring David. Tell me again about red wine…