January 01, 2020

I have stable heart disease with some symptoms. Do I need an artery-widening stent?

Q: I have a clogged heart artery. My doctors said it's stable and prescribed medications for it, but it still causes discomfort when I exercise, and I'm worried about having a heart attack. Should I ask about getting a stent?

A: When one or more arteries supplying the heart with blood have narrowed, poor blood flow can result in ongoing pain or discomfort in your chest (angina). Stable angina means the pain and discomfort are predictable and the angina maintains generally the same pattern. It occurs with certain circumstances, usually with exercise, and is relieved by rest or with a medication.

It's true that under some circumstances, people with persistent stable angina may be good candidates for stent placement — where small mesh tubes are placed in a narrowed artery to widen it — especially if they have more serious heart disease.

However, for many people with mild to moderate heart disease, stable angina can be effectively treated with lifestyle changes and daily medications. Even when stable angina persists, moving on to placing a stent isn't a surefire decision. Stent placement may reduce the frequency of chest discomfort immediately after the procedure. However, it's unlikely to reduce your risk of a future heart attack or impact longevity. On the other hand, stents can be very effective in relieving symptoms if the angina is more severe or if medications aren't completely effective or well tolerated.

After stent placement, you still need to take medications regularly, including anti-clotting drugs such as baby aspirin. There are also certain risks — though small — associated with stent placement. During the first few months after placement, a few people experience bleeding due to the anti-clotting medications or occasionally develop a blood clot in the stent that leads to...