Medication vs. Stent treatment for coronary artery disease

Posted by vic83 @vic83, Jan 12 10:53pm

Recent angiogram revealed a 70-80% blockage in LAD. That is the minimum blockage to stent. Because of upcoming surgery, I was put on medication and not stented. Later one of the cardiologists did tell me that recent research has shown that medication can be as effective as stenting in most cases. I am wondering if anyone has made the choice of medication vs. stent and on what basis. Stenting is not risk free, and prohibits any surgery for a significant amount of time.

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I had 5 drug eluding stents for 16 years after 3 blocked arteries 75-90% and heart attack. September of 2020 revealed 3 stents were blocked. We’ll treat this with medication. My blood pressure was elevated and didn’t change on meds. They attempted restenting which was unsuccessful. I was released from the hospital with”normal” heart function to schedule bypass surgery. Three days later I was admitted to hospital with a heart attack. I would say meds wouldn’t have worked for me. My cardiologist said your heart develops other pathways for blood supply. So there is a theory about not revascularizing????????

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@vic83 Hello Vic. I had a heart attack in July 2021 and, bc I'm a poor risk surgically, I was put on medication rather than having the stent procedure. I take 1/2 tablet twice a day of Metoprolol 25 mg (12.5 mg twice a day). So far, so good! The stent procedure can be very risky, as you say. My sister, aged 86, was in the midst of a heart attack when they tried an emergency stent procedure. However,
it was too late for her, and she didn't survive the procedure. Please don't be afraid if you do go that route. I know MANY people who have stents, including one of my sons, and everyone tells me a stent changed their lives so much, and for the better. Warmest wishes, Laurie

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Crestor and Zetia

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@artist01

@vic83 Hello Vic. I had a heart attack in July 2021 and, bc I'm a poor risk surgically, I was put on medication rather than having the stent procedure. I take 1/2 tablet twice a day of Metoprolol 25 mg (12.5 mg twice a day). So far, so good! The stent procedure can be very risky, as you say. My sister, aged 86, was in the midst of a heart attack when they tried an emergency stent procedure. However,
it was too late for her, and she didn't survive the procedure. Please don't be afraid if you do go that route. I know MANY people who have stents, including one of my sons, and everyone tells me a stent changed their lives so much, and for the better. Warmest wishes, Laurie

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Thanks for sharing. I had lung cancer surgery planned so placing a stent would have prohibited that surgery (no
surgery if one is on antiplatelet therapy). I have to consider now whether I will need further lung surgery in the future. One cardiologist did mention that recent research indicates that many people will do as well on medication as with stent (ISCHEMIA trial). If stent is only to help with pain, I never had much pain. The whole thing started with shortness of breath which I thought was lungs. I became anxious and that increased my shortness of breath and in the last 2 weeks I begin to have dull chest pain. I went to ER for something else and they picked up on elevated Troponin (0.4 up to 0.6 down to 0.4). The next day they did angiogram and discovered the blockage of 70%. So I am now on medication and do not have any chest pain (IMDUR 30 MG, TOPROL XL 25MG, ATORVASTIN 40MG). I am 80 now and tolerated my lung surgery well. "Technically" they said I had a heart attack but I had no heart damage as I did an Echo Stress test a week later with no problem. I want to make decisions based on latest research and my own health profile. I cannot do a stent in this moment, and the question is whether a stent is much better for me than medication. Does it prevent pain (I don't have) or does it prevent heart attack more than medication???? And what are the other risks? I don't like incomplete answers.

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@vic83 Hi Vic. From what I've learned from my Cardiologist and my research on the subject, it seems widely believed nowadays that medication is as equally beneficial as a stent. The one med apparently widens the artery and keeps it open. You can research your meds and you'll learn what they can do for you. I also type "mayoclinic" as a trusted site and then type in the name of the drug. You can also go to "drugs.com" for info.
I had no chest pain either, just a small pain in my shoulder, which I thought was a small muscle or tendon injury, but my troponin kept climbing all day. The doctor kept coming in to say, "You're 'having' a heart attack". At the end of the day she finally announced "You've 'had' a heart attack".
And isn't all of medicine mostly incomplete answers? Doctors are only human and you just have to put your faith in them. Good luck with your research! Warmest regards, Laurie

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@artist01

@vic83 Hi Vic. From what I've learned from my Cardiologist and my research on the subject, it seems widely believed nowadays that medication is as equally beneficial as a stent. The one med apparently widens the artery and keeps it open. You can research your meds and you'll learn what they can do for you. I also type "mayoclinic" as a trusted site and then type in the name of the drug. You can also go to "drugs.com" for info.
I had no chest pain either, just a small pain in my shoulder, which I thought was a small muscle or tendon injury, but my troponin kept climbing all day. The doctor kept coming in to say, "You're 'having' a heart attack". At the end of the day she finally announced "You've 'had' a heart attack".
And isn't all of medicine mostly incomplete answers? Doctors are only human and you just have to put your faith in them. Good luck with your research! Warmest regards, Laurie

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Thanks for your input. The ER kept me because my Troponin was 0.04. The next day they proposed an angiogram, When the cardiologist found a blockage, I reminded them that I had a lung mass to biopsy. They said they could medicate. I worried if I were doing the right thing. Fortunately, the next morning one cardiologist told me that latest research says one can manage with medication, so I felt better. I had stage 1 lung cancer so I made a very smart call by not doing the stent. I have researched my medications and they do as you pointed out. I also read that cardiologists were doing stents on people who didn't need them so the government set a minimum requirement of 70% blockage to do a stent. Therefore I want to see research on medication management vs. stents for blockages greater than 70%. Also location of blockage may have an impact.

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Vic, check out the other lifestyle changes needed with meds. If you want to be really aggressive look up dr. dean ornish and dr. Caldwell Esselstyn (on YouTube) to consider for lifestyle guidance in addition to meds (aggressive lifestyle but studied in medical journals). Most importantly make sure a cardiologist is in agreement with your plan and managing (sounds like they are and managing). If you do need stents or surgery and you can, consider trip to mayo or second opinion or good place if time allows.

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Hi @vic83 One of my friends had a heart attck and rather than stents he opted for EECP – Enhanced External Counterpulsation. The treatment involves compressing blood vessels in the lower limbs to increase bloodflow to the heart. It worked for him. All the best.

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@tsc

Hi @vic83 One of my friends had a heart attck and rather than stents he opted for EECP – Enhanced External Counterpulsation. The treatment involves compressing blood vessels in the lower limbs to increase bloodflow to the heart. It worked for him. All the best.

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Thanks for the information. I think it is important to have as much information as possible in order to make wise choices.

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@vic83

Thanks for the information. I think it is important to have as much information as possible in order to make wise choices.

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You're welcome. Good luck!

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